Holiday Assistance ApplicationStep 1 of 250%Name*Phone*Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please list all adults over 18 that live in your household permanently (including yourself):*First nameLast NameDate of Birth Please list all children under the age of 18 that live in your household permanently*First nameLast NameDate of BirthSchoolProof of Residency Please select your race*AsianBlack/African AmericanHispanicWhiteOtherPlease circle your yearly income level*under $13,000$13,000-$23,000$23,001-$33,000$33,001-$43,000$43,001-aboveHave you or do you plan to apply to receive holiday assistance from any other agency this year?*YesNoIf yes, what is the name of the agency?Franklin Community Center, Inc. will be checking with all other agencies to verify that you are not receiving assistance from any other group. You are hereby authorized to furnish and release any and all information and records that are requested by Franklin Community Center, Inc. and give Franklin Community Center, Inc. permission to discuss this application with other agencies as necessary. If we find that you are dishonest in your application in any way or have applied elsewhere for assistance, you will be ineligible for assistance at any agency.Number of Children You're Seeking Assistance for*Please enter a number from 1 to 6.Child 1First Name of Child*Age*GenderBoyGirlOtherSomething you WANTFirst ChoiceSecond ChoiceThird ChoiceSomething you NEEDFirst ChoiceSecond ChoiceThird ChoiceSomething you WEARFirst ChoiceSecond ChoiceThird ChoiceSomething you READFirst ChoiceSecond ChoiceThird ChoiceSize Info (Be Specific)Child Tops Boys GirlsChild Tops Size XXS XS S M L XL XXLChild Tops Numeric SizeChild Bottoms Boys GirlsChild Bottoms Size XXS XS S M L XL XXLChild Bottoms Numeric SizeAdult TopsMenWomenJunior (Girls)Adult Tops Size XXS XS S M L XL XXLAdult Tops Numeric SizeAdult BottomsMenWomen/JuniorAdult Bottoms Size XXS XS S M L XL XXLAdult Bottoms Numeric SizeShoe Size InfoInfantToddlerYouthWomenMenShoe SizeFavorite ColorsPlease select any Red Orange Yellow Green Blue Purple Pink White BlackInterests/HobbiesPlease select any Arts and Crafts Building Toys Dolls – Baby, LOL, Barbie, Bratz Board/Card Games Cars and Trucks Puzzles SportsFavorite Sports TeamFavorite TV and Movies CharactersOther Favorite CharactersChild 2First Name of Child*Age*GenderBoyGirlOtherSomething you WANTFirst ChoiceSecond ChoiceThird ChoiceSomething you NEEDFirst ChoiceSecond ChoiceThird ChoiceSomething you WEARFirst ChoiceSecond ChoiceThird ChoiceSomething you READFirst ChoiceSecond ChoiceThird ChoiceSize Info (Be Specific)Child Tops Boys GirlsChild Tops Size XXS XS S M L XL XXLChild Tops Numeric SizeChild Bottoms Boys GirlsChild Bottoms Size XXS XS S M L XL XXLChild Bottoms Numeric SizeAdult TopsMenWomenJunior (Girls)Adult Tops Size XXS XS S M L XL XXLAdult Tops Numeric SizeAdult BottomsMenWomen/JuniorAdult Bottoms Size XXS XS S M L XL XXLAdult Bottoms Numeric SizeShoe Size InfoInfantToddlerYouthWomenMenShoe SizeFavorite ColorsPlease select any Red Orange Yellow Green Blue Purple Pink White BlackInterests/HobbiesPlease select any Arts and Crafts Building Toys Dolls – Baby, LOL, Barbie, Bratz Board/Card Games Cars and Trucks Puzzles SportsFavorite Sports TeamFavorite TV and Movies CharactersOther Favorite CharactersChild 3First Name of Child*Age*GenderBoyGirlOtherSomething you WANTFirst ChoiceSecond ChoiceThird ChoiceSomething you NEEDFirst ChoiceSecond ChoiceThird ChoiceSomething you WEARFirst ChoiceSecond ChoiceThird ChoiceSomething you READFirst ChoiceSecond ChoiceThird ChoiceSize Info (Be Specific)Child Tops Boys GirlsChild Tops Size XXS XS S M L XL XXLChild Tops Numeric SizeChild Bottoms Boys GirlsChild Bottoms Size XXS XS S M L XL XXLChild Bottoms Numeric SizeAdult TopsMenWomenJunior (Girls)Adult Tops Size XXS XS S M L XL XXLAdult Tops Numeric SizeAdult BottomsMenWomen/JuniorAdult Bottoms Size XXS XS S M L XL XXLAdult Bottoms Numeric SizeShoe Size InfoInfantToddlerYouthWomenMenShoe SizeFavorite ColorsPlease select any Red Orange Yellow Green Blue Purple Pink White BlackInterests/HobbiesPlease select any Arts and Crafts Building Toys Dolls – Baby, LOL, Barbie, Bratz Board/Card Games Cars and Trucks Puzzles SportsFavorite Sports TeamFavorite TV and Movies CharactersOther Favorite CharactersChild 4First Name of Child*Age*GenderBoyGirlOtherSomething you WANTFirst ChoiceSecond ChoiceThird ChoiceSomething you NEEDFirst ChoiceSecond ChoiceThird ChoiceSomething you WEARFirst ChoiceSecond ChoiceThird ChoiceSomething you READFirst ChoiceSecond ChoiceThird ChoiceSize Info (Be Specific)Child Tops Boys GirlsChild Tops Size XXS XS S M L XL XXLChild Tops Numeric SizeChild Bottoms Boys GirlsChild Bottoms Size XXS XS S M L XL XXLChild Bottoms Numeric SizeAdult TopsMenWomenJunior (Girls)Adult Tops Size XXS XS S M L XL XXLAdult Tops Numeric SizeAdult BottomsMenWomen/JuniorAdult Bottoms Size XXS XS S M L XL XXLAdult Bottoms Numeric SizeShoe Size InfoInfantToddlerYouthWomenMenShoe SizeFavorite ColorsPlease select any Red Orange Yellow Green Blue Purple Pink White BlackInterests/HobbiesPlease select any Arts and Crafts Building Toys Dolls – Baby, LOL, Barbie, Bratz Board/Card Games Cars and Trucks Puzzles SportsFavorite Sports TeamFavorite TV and Movies CharactersOther Favorite CharactersChild 5First Name of Child*Age*GenderBoyGirlOtherSomething you WANTFirst ChoiceSecond ChoiceThird ChoiceSomething you NEEDFirst ChoiceSecond ChoiceThird ChoiceSomething you WEARFirst ChoiceSecond ChoiceThird ChoiceSomething you READFirst ChoiceSecond ChoiceThird ChoiceSize Info (Be Specific)Child Tops Boys GirlsChild Tops Size XXS XS S M L XL XXLChild Tops Numeric SizeChild Bottoms Boys GirlsChild Bottoms Size XXS XS S M L XL XXLChild Bottoms Numeric SizeAdult TopsMenWomenJunior (Girls)Adult Tops Size XXS XS S M L XL XXLAdult Tops Numeric SizeAdult BottomsMenWomen/JuniorAdult Bottoms Size XXS XS S M L XL XXLAdult Bottoms Numeric SizeShoe Size InfoInfantToddlerYouthWomenMenShoe SizeFavorite ColorsPlease select any Red Orange Yellow Green Blue Purple Pink White BlackInterests/HobbiesPlease select any Arts and Crafts Building Toys Dolls – Baby, LOL, Barbie, Bratz Board/Card Games Cars and Trucks Puzzles SportsFavorite Sports TeamFavorite TV and Movies CharactersOther Favorite CharactersChild 6First Name of Child*Age*GenderBoyGirlOtherSomething you WANTFirst ChoiceSecond ChoiceThird ChoiceSomething you NEEDFirst ChoiceSecond ChoiceThird ChoiceSomething you WEARFirst ChoiceSecond ChoiceThird ChoiceSomething you READFirst ChoiceSecond ChoiceThird ChoiceSize Info (Be Specific)Child Tops Boys GirlsChild Tops Size XXS XS S M L XL XXLChild Tops Numeric SizeChild Bottoms Boys GirlsChild Bottoms Size XXS XS S M L XL XXLChild Bottoms Numeric SizeAdult TopsMenWomenJunior (Girls)Adult Tops Size XXS XS S M L XL XXLAdult Tops Numeric SizeAdult BottomsMenWomen/JuniorAdult Bottoms Size XXS XS S M L XL XXLAdult Bottoms Numeric SizeShoe Size InfoInfantToddlerYouthWomenMenShoe SizeFavorite ColorsPlease select any Red Orange Yellow Green Blue Purple Pink White BlackInterests/HobbiesPlease select any Arts and Crafts Building Toys Dolls – Baby, LOL, Barbie, Bratz Board/Card Games Cars and Trucks Puzzles SportsFavorite Sports TeamFavorite TV and Movies CharactersOther Favorite CharactersPhoneThis field is for validation purposes and should be left unchanged.
