School Supplies Application | Center for Family Services, Inc.

Adult or Guardian Information

Please fill out all required information. Submission of this form does not guarantee that your student(s) will receive supplies.

First Name *

Last Name *

Street Address

City *

Zip code *

Annual Household Income *

Email Address *

Best Phone Number *

Student Information

If you are applying for more than four students, please submit an additional form and advise us in the comments section. Thank you!

Student #1

First Name

Last Name

Is your student a

Girl

Boy

Student's grade as of September 1, 2016

School your student will be attending as of September 1, 2016

Student needs

Just a book bag

Just supplies

Book bag and supplies

Student #2

First Name

Last Name

Is your student a

Girl

Boy

Student's grade as of September 1, 2016

School your student will be attending as of September 1, 2016

Student needs

Just a book bag

Just supplies

Book bag and supplies

Student #3

First Name

Last Name

Is your student a

Girl

Boy

Student's grade as of September 1, 2016

School your student will be attending as of September 1, 2016

Student needs

Just a book bag

Just supplies

Book bag and supplies

Student #4

First Name

Last Name

Is your student a

Girl

Boy

Student's grade as of September 1, 2016

School your student will be attending as of September 1, 2016

Student needs

Just a book bag

Just supplies

Book bag and supplies

Distribution for 2016 will take place August 18th & 19th from 9am - 4pm at Center for Family Services, Inc., 213 W. Center Street, Meadville. Submission of this form does not guarantee that your student(s) will receive supplies. We will do our best to contact those who we will not be able to help. Check this box stating that you understand. *

I have read and understood the above statement.

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