Care Package Request Form
Thank you for your interest in our programs. When possible, we invite children who meet the criteria listed below to shop with us in person at our facility (2623 5th Ave., Unit 102 in Rock Island) on Thursdays between 4-8 pm. For children who have transportation or other barriers, a custom care package may be requested.

Social workers or approved school personnel are invited to submit a care package request if the child for whom you are submitting the form meets the following criteria:

- Child or young adult who is 20 years-old or younger.

-Currently a foster child or a child who is experiencing homelessness.

-Lives in the Quad Cities community in Iowa/Illinois.

Please note that contents of packages are subject to inventory availability.

Registered clients may receive care packages up to 4 times per year. Representatives from social service agencies or schools will need to pick up care packages at our facility within 30 days of the date they are requested. You will be emailed pick up dates/times after your order is processed.

If you have questions, please call or text 309-235-8786 or email info@closet2closet.org
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Email *
INFORMATION ABOUT THE CHILD WHO WILL RECEIVE THE CARE PACKAGE
Name or initials
Age
Grade/Year in School
Gender
Name of School
Shoe Size
Please select 1 option for Shirts/Tops:
Clear selection
Select 1 option for bottom size:
Clear selection
If available, would you like us to include hygiene items such as deodorant, shampoo, or body wash in the care package?
Clear selection
If available, does this child need sulfate-free shampoo specialized for natural, curly hair?
Clear selection
Please list bra size for girls or young women:
INFORMATION ABOUT THE PERSON SUBMITTING THE FORM
Name of person making this referral.
Agency/school affiliation for person making this referral.
Phone number of person making this referral.
Comments about child's style, favorite colors, or other information to help us optimally customize this care package:
Submit
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This form was created inside of Augustana College.