Betty Walker Waites Foundation - Robert Guardian Angel Shoe Program Assistance Application

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Thank you for your interest in the Robert Guardian Angel Shoe Program through the Betty Walker Waites Foundation.

This program provides limited shoe assistance to eligible low-income children and youth based on verified need, available funding, available inventory, and program guidelines.

IMPORTANT PROGRAM RULES:
- Assistance is limited to one (1) pair of shoes per eligible child/youth per calendar year
- Only one application per child/youth will be reviewed within a 12-month period
- Submission of this form does NOT guarantee approval
- All applications are subject to review, verification, and approval
- Incomplete, duplicate, false, altered, or misleading applications may be automatically denied
- Families may be asked to provide additional documentation before approval
- Approved recipients must follow pickup/photo/program participation requirements
- Shoes provided through this program are intended for the approved child/youth only
- Shoes may not be transferred, exchanged for cash, sold, traded, or given away

By submitting this application, you acknowledge and agree to all program rules and verification procedures.

Email *

Record my email address with my response

SECTION 1: PARENT / GUARDIAN INFORMATION

1. Parent/Guardian Full Name *

2. Phone Number *

3. Email Address *

4. Full Home Address *

5. City *

6. State *

7. ZIP Code *

SECTION 2: CHILD / YOUTH INFORMATION

8. Child/Youth Full Name *

9. Date of Birth *

YYYY

10. Age *

11. School Name (if applicable)

12. Grade Level *

13. Shoe Size Needed *

14. Type of Shoes Requested *

School Shoes

Athletic/Tennis Shoes

Casual Shoes

Dress Shoes

Work Shoes

Other

SECTION 3: HOUSEHOLD ELIGIBILITY / NEED

15. Total Number of People in Household *

16. Total Number of Children in Household *

17. Current Monthly Household Income Range *

$0 – $1,000

$1,001 – $2,000

$2,001 – $3,000

$3,001 – $4,000

$4,001 or more

Prefer not to answer

18. Does your household currently receive any of the following? *

SNAP / Food Stamps

Medicaid / CHIP

SSI / Disability

TANF

Housing Assistance / Section 8

Free or Reduced Lunch

Unemployment

None

Prefer not to answer

Required

19. Please explain why your child/youth is currently in need of shoe assistance. *

Please be specific. Applications may be denied if no explanation is provided.

SECTION 4: PRIOR ASSISTANCE / DUPLICATE CHECK

20. Has this child/youth received shoes from Betty Walker Waites Foundation within the last 12 months? *

Yes

Not sure

21. Has anyone in your household already applied for or received shoe assistance from Betty Walker Waites Foundation this year? *

Yes

Not sure

22. If yes, list the name(s) of anyone in your household who has already applied for or received shoe assistance.

SECTION 5: REQUIRED DOCUMENTATION

23. Proof of Household Need or Income *

Upload is not supported by Apps Script unless using a Workspace domain. If needed, ask families to email or text proof after submitting. Accepted examples include: SNAP/benefits letter, Medicaid/CHIP letter, SSI/disability letter, unemployment letter, free/reduced lunch letter, recent pay stub, or other official document showing current hardship/need.

24. Parent/Guardian Photo ID *

Upload is not supported here by script for many accounts. Ask applicant to email or present at pickup.

25. Proof of Child/Youth (if requested)

Examples: school record, report card, birth certificate, Medicaid card, or another official document showing child/youth name.

SECTION 6: STRICT PROGRAM RULES & AGREEMENTS

26. One-Time Annual Assistance Rule *

I understand that shoe assistance is limited to one (1) pair of shoes per eligible child/youth per calendar year, and repeat requests within the same year may be denied.

Required

27. Duplicate / Fraud Prevention Agreement *

I understand that duplicate applications, false information, altered documents, use of another person’s information, or misrepresentation of need may result in immediate denial and may disqualify my household from future assistance programs.

Required

28. No Transfer / No Resale Rule *

I understand that shoes received through this program are for the approved child/youth only and may not be sold, traded, transferred, exchanged, or used for personal profit.

Required

29. Pickup Requirement *

I understand that if approved, I must follow all pickup instructions, deadlines, and verification requirements provided by Betty Walker Waites Foundation.

Required

30. Child Must Be Present Rule *

I understand that the approved child/youth may be required to be present at pickup or distribution unless otherwise approved by Betty Walker Waites Foundation.

Required

31. No Call / No Show Rule *

I understand that if I fail to pick up approved assistance by the assigned deadline without prior communication, my assistance may be forfeited and reassigned to another family in need.

Required

32. Photo Requirement *

I understand that if approved, participation may require taking a photo with the shoes, Betty Walker Waites Foundation staff/volunteers, and/or nonprofit logo/signage for program accountability and donor reporting.

Required

33. Media Release / Donor Use Permission *

I give Betty Walker Waites Foundation permission to use approved photos taken during this program for donor reports, grant reports, fundraising, website, social media, newsletters, promotional materials, and community outreach purposes.

Required

34. Release of Liability / Program Discretion *

I understand that Betty Walker Waites Foundation reserves the right to approve, deny, limit, verify, or discontinue assistance at its sole discretion based on funding, inventory, eligibility, safety, and program guidelines.

Required

35. Truth & Accuracy Statement *

I certify that all information and documents submitted are true, accurate, and complete to the best of my knowledge.

Required

36. Electronic Signature *

Type your full legal name as your electronic signature.

37. Date *

YYYY

SECTION 7: ADDITIONAL SCREENING

38. Are you applying for this child/youth through any other shoe assistance program at this time? *

Yes

Not sure

39. Have you received similar shoe assistance for this child/youth from another organization within the last 6 months? *

Yes

Not sure

40. How did you hear about this program?

Submit

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