Free Christmas Assistance Application Form Template

Christmas Assistance Application Form

Please fill in the fields below to be considered for assistance.

Date

    Name

      Address

        Phone Number

          Email

            No. of Household Members

              Ages of Children (if applicable)

                Type of Assistance Needed

                  • Food

                  • Clothing

                  • Gift Cards

                  • Financial Assistance for Utilities

                  Special Needs or Circumstances

                    Please check the box below to proceed

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