Shopping with Carter's House
Thank you so much for reaching out to Carter's House for assistance. To be eligible for our service you MUST meet one of the following requirements: 1. Be currently receiving State benefits, i.e. TANF, SNAP, Child Care, or Housing. 2. Your child(ren) are receiving Free or Reduced lunch. You are REQUIRED to provide a copy of your award letter that you meet ONE of the above requirements when you come in for your appointment. All children you will be shopping for MUST be listed on the letter. SSI letters are NOT acceptable forms of verification!!!

To ensure the most enjoyable shopping experience, please completed ALL questions below. We look forward to having you shop with us.

Email address *
Who were you referred by? *
Your answer
What is the date of your shopping appointment? *
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What time was your appointment scheduled? *
Time
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Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Are you a grandparent raising your grandchildren? *
Parent's Telephone Number *
Your answer
Street Address? *
Your answer
City and Zip Code *
Your answer
Are your children eligible for free/reduced lunch? *
Are you and your children homeless? *
If your answer is no, where do you live? *
Is anyone in the household a Veteran? *
If yes, please indicate where you served. *
What is your ethnicity? *
How may children will you be shopping for during your visit? *
Your answer
Child 1: Please indicate the Name/ Age/ Gender/ Sizes (top, bottom and shoe) and what school they attend? *
Your answer
Child 2: Please indicate the Name/ Age/ Gender/ Sizes (top, bottom and shoe) and what school they attend?
Your answer
Child 3: Please indicate the Name/ Age/ Gender/ Sizes (top, bottom and shoe) and what school they attend?
Your answer
Child 4: Please indicate the Name/ Age/ Gender/ Sizes (top, bottom and shoe) and what school they attend?
Your answer
Child 5: Please indicate the Name/ Age/ Gender/ Sizes (top, bottom and shoe) and what school they attend?
Your answer
Child 6: Please indicate the Name/ Age/ Gender/ Sizes (top, bottom and shoe) and what school they attend?
Your answer
If any of the above requests are for school uniforms, please indicate acceptable shirt/pants colors for each child.
Your answer
I hereby certify that all of the information that I have provided is true and accurate to the best of my knowledge. I understand that intentional falsification of any information on this application will result in denial of services. *
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