Back to School Supplies Application

School Supplies Request Form

Pick-up will be in August, date TBD. We have a limited number of supplies, so please only apply if this is truly a need for your family.
Name(Required)
Partner's Name
Address(Required)
Preferred Method of Communication:(Required)
Average MONTHLY Income (includes wages/paychecks, MDHHS benefits, etc.) - please note this will NOT affect your ability to receive assistance, it is just for our records.(Required)