Register for Help with School Supplies
A Ministry of the Hardee County Ministerial Association:
Hardee Help Center
Attn: Stephanie Leakey, Client Services Coordinator
713 E. Bay Street
Wauchula, FL 33873
Tele: 863-773-0034
Help with school supplies for Hardee County students (K-12) is available.
PRE-REGISTRATION IS REQUIRED. NO WALK-INS. APPOINTMENTS REQUIRED.
Grade appropriate supplies are distributed in the order registrations are received. School supplies are limited. If the need exceeds the supply available then a wait list will be created and families will be contacted should additional supplies become available.
Submit your registration and you will be contacted by phone by a Hardee Help Center Team Member to schedule pick up of your child's school supplies.
Documents & Information needed:
1. Photo Identification (Only the child's legal guardian can request assistance)
2. Proof of physical address (Must be a Hardee County resident)
3. Child's Name, DOB, 2020-2021 Grade Level, and School (Students must be attending a Hardee County Public School or enrolled in one of the virtual options)
Documents need to be presented when picking up your child's school supplies.
>>>> The person who is registering/completing this form must be the child's legal guardian and certify the information provided is accurate.
* Required
Applicant's First Name, Last Name (Adult Household Member)
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Your answer
Are you a member of a local church? If so, which church?
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Your answer
Phone Number (xxx-xxx-xxxx)
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Your answer
Current Physical Address (Ex. 713 E. Bay Street, Wauchula)
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Your answer
Adult Household Member DOB
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MM
/
DD
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YYYY
Adult Household Member Last Four Social Security Numbers (xxxx)
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Your answer
Gender?
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Choose
Female
Male
Adult Household Member Marital Status:
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Choose
Married
Single
Separated
Divorced
Widowed
Disabled
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Choose
Yes
No
Veteran
*
Choose
Yes
No
Race
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Choose
White
Black
Native Hawaiian/other Pacific Islander
Asian
American Indian
Other
Ethnicity
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Choose
Hispanic
Non-Hispanic
Housing?
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Choose
Own
Rent
Homeless
Other
Select your households annual income range.
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Choose
0 - 9,999
10,000 - 29,999
30,000 - 49,999
Over 50,000
Number of Household Members?
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Choose
1
2
3
4
5
6
7
8
9
10
Number of children you are registering.
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Choose
1
2
3
4
5
6
7
Child Number 1 (Full Name, DOB, 2020-2021 Grade Level, School Name)
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Your answer
Child Number 2 (Full Name, DOB, 2020-2021 Grade Level, School Name)
Your answer
Child Number 3 (Full Name, DOB, 2020-2021 Grade Level, School Name)
Your answer
Child Number 4 (Full Name, DOB, 2020-2021 Grade Level, School Name)
Your answer
Child Number 5 (Full Name, DOB, 2020-2021 Grade Level, School Name)
Your answer
Child Number 6 (Full Name, DOB, 2020-2021 Grade Level, School Name)
Your answer
Child Number 7 (Full Name, DOB, 2020-2021 Grade Level, School Name)
Your answer
I acknowledge the information I submitted above, or by phone with Hardee Help Center Personnel was truthful and accurate. No fraudulent information was provided in order to obtain services that I would otherwise not likely qualify for.
*
Choose
Yes
No
I acknowledge the information I have provided is shared with the local churches, as the Hardee Help Center is a ministry of the Hardee County Ministerial Association. That any willful misstatement of information will be grounds for disqualification AND I may no longer receive assistance through the Hardee Help Center in the future.
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Choose
Yes
No
By selecting 'Yes' below I hereby authorize the release without liability, information regarding my residency, employment, income, and/or assets to HARDEE HELP CENTER, for the purposes of verifying information provided as part of determining eligibility for assistance under the Hardee Help Center’s Basic Need Program. I understand that only information necessary for determining eligibility can be requested. Types of Information to be verified: I understand that previous or current information regarding me may be required. Verifications that may be requested are, but not limited to: employment history, hours worked, salary and payment frequency, commissions, raises, bonuses, and tips; cash held in checking/savings accounts, stocks, bonds, certificated of deposits, Individual Retirement Accounts, interest, dividends; payments from Social Security, annuities, insurance policies, retirement funds, pensions, disability or death benefits, unemployment, disability or worker’s compensation, net income from the operation of a business, property exemption status, and alimony or child support payments.
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Choose
Yes
No
Signature is required. By typing your name below, this is your digital signature. You are signing this Form electronically.
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Your answer
Date Submitted
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MM
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DD
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YYYY
Time Submitted
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Time
:
AM
PM
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