CSSY Pesach Application 2019
Bringing the joy and celebration of Shabbos and Yom Tov to hundreds of homes throughout the Crown Heights Community.

Kindly complete this online application so Chevra Simchas Shabbos V'YomTov can better assist you.

Should you find it difficult to complete this application, please contact us at 718-774-5270 or email cssyoffice@gmail.com.

Applicant First Name *
Your answer
Last Name *
Your answer
Spouse Name *
Your answer
Email Address *
Your answer
Address *
Your answer
Apartment
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Number
Your answer
Cell Phone Number *
Your answer
Do you rent or own a home? *
Required
Marriage Status *
How many children do you have? *
Your answer
How many children will be home for Pesach? *
Your answer
Will you be home for Pesach? *
Are you hosting guests for Pesach? If so, how many?
Your answer
Do you receive government assistance? Please indicate which: *
Required
Do you receive assistance for Pesach from other organizations? *
Required
Reference #1 (Name & Phone Number) *
Your answer
Reference #2 (Name & Phone Number) *
Your answer
Comments:
Your answer
*Applying is not a guarantee that services will be provided.* Though CSSY will attempt to help all individuals in need of kosher food, in the case of limited resource, the organization will prioritize candidates based on need and first come – first serve basis.
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