4 SEASON GIVING TREE SCHOOL REFERRAL FORM
All families referred to this program require a referral by a Montgomery County Public School or Frederick County Pupil Personnel Worker, Counselor, Parent Coordinator, or teacher. 

Families being referred to the holiday program should be considered as having critical needs, who are in need of the most support. To ensure that we are able to help the maximum number of families in need, if a family is receiving help from another holiday program, they should not be referred below. 

This program helps families in need in Montgomery County by providing gently used donated items/clothing as available. Items will be provided at the family's doorstep as they are available on a random basis. There is no guarantee that items requested will be donated, however we will try to get the families the items they requested. 

This program provides assistance primarily in 20878 and Frederick. If families are referred outside of these areas, it requires for the school staff who referred this family to pick the items up from a central location in 20878 or in Frederick.  We cannot easily accommodate requests outside of 20878 or Frederick at this time. 

Donating families/volunteers will be provided with the address of the family to leave items off at their doorstep.

Also, please note that other community members will help with deliveries of the items requested to get the below needs met, so family address information will be shared. 
Sign in to Google to save your progress. Learn more
What is your email address?
What is your name?
What is your phone number?
What school do you represent?
If your school is not listed above, please list below.
What is your role at the school?
What is the name of the family you are referring?
What is the email address of the primary contact of the family?
What is the phone number of the primary contact of the family?
What is the physical address of the family for delivery? If this family is located outside of 20878 or Frederick, we cannot accommodate this request unless the school staff member is able to pick up and deliver items from a central location in 20878 or Frederick. Please note any items will be delivered to their front stoop without notice. Please include any special instructions (code at front of bldg to get in, etc.)
Provide a description of the family circumstances that can be shared. Sharing specific details about the situation helps generate support. Note, no names are ever made public. Each family is assigned a number. 
If gift cards are able to be provided, please list the stores gift cards should be provided for. (Example, Target, Panera, Walmart, Safeway, Giant, Aldi, etc.) 
How many family members are there in the family?
Clear selection
Please list any details about needs you are aware of here and please be specific, and indicate exact items needed. Please list AGE, GENDER AND CLOTHING SIZES NEEDED as well as any other items the family may need, including furniture, as we are sometimes offered furniture that can be delivered to their doorstep if the family resides in 20878 ONLY. Examples of needed items are: Specific non-perishable foods like rice, canned black beans, canned tuna, toothbrushes, twin sheets, etc.
Please let the family know that they will receive items on a random basis at their doorstep without notice by this organization. 
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report