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Case Workers/School Staff Request Form Basics for Local Kids 2022-2023
One form for EACH child.
Kids ages newborn through 18 years old living in Pierce or St. Croix counties in Wisconsin are eligible.
(If you have a situation outside of the area that we should consider, please email for preapproval to info@basicsforlocalkids.org.)
Please encourage families to attend an in-person distribution event on
9/24 at ELLSWORTH Middle School or
10/22 at NEW RICHMOND Middle School.
They can pre-register for the event at
Basics for Local Kids
.
If the family can not attend a distribution event or the event has passed, please continue with this request form.
Selection variety is based on donations. We do our best, but can not guarantee availability.
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* Indicates required question
Email
*
Your email
Case worker or staff name (first and last)
*
Your answer
Agency or school name
*
Your answer
Are you requesting on behalf of child as a:
*
Case Worker
School Staff
Other:
City/Town or School District child lives in
*
Your answer
County child lives in
*
Pierce County, WI
St. Croix County, WI
Other
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