ABC Application

ABC Application

Our school is able to help families in need on a limited basis with specific items such as school supplies, clothes, shoes, food and other emergency needs. Our district is able to provide this assistance through donations made by private citizens, community organizations, and School Board employees. Please understand that specific needs may not be met due to unavailability of supplies or lack of funding. If the school is unable to meet your needs, the ABC representative will diret you to appropriate resources in the commmunity. Please list only school aged children in your family currently living in your home.

Date Date / MM / DD YYYY
Parent/Guardian Name Parent/Guardian Name First Last
Phone Phone - ### - ### ####
Student Name Student Name First Last
Student Number
Grade Level

Grade Level 9th 10th 11th 12th
Please check all that you need or would like assistance with

Please check all that you need or would like assistance with School supplies Clothes/Shoes Food Fees Other
If you checked "other" please provide your request below
By checking the box below, I give permission for my child(ren) to receive help.

By checking the box below, I give permission for my child(ren) to receive help. I acknowledge
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.