Christmas Assistance | KevinRileyFoundation

Christmas Assistance Application

Application Period 9/21/24 - 10/21/24

Requirements:

1. Must live in Winchester / Frederick County / Clarke County

2. Must have custody of child/children

3. Ages 17 & Under

4. Must have ID, show proof of address, and birth certificate for each child registered

5. Must not be registered for assistance with any other group, organization or church

6. Must be able to pick up gifts Saturday December 14th. Photo ID will be required to pick up gifts.

**Application will allow 2 children to be registered, if more than 2 children you will need to complete a second application.

**We will accept a limited number of children. You will be contacted and notified if your application is accepted or if we are unable to assist for Christmas 2024.

ApplicantFirst name

Applicant Last name

Birthday

Applicant Email

Phone

Address

Do you Own or Rent

Gender

Race

Are you the custodial parent for the children you are applying for?

Do you receive TANF?

Do you receive SNAP?

Do you receive SSI?

Do you receive Social Security or Disability?

Have you applied for Christmas Assistance with any other agency, church or organization?

Yes

I understand completing this application does not guarantee acceptance of application. If accepted I hereby release this information to be shared with other groups and organizations for assistance or verification.

Yes

List how Many Adults live in the household

List all adults residing in the household. Include: Name, Relationship, Age, and Income. You MUST list the income here!!

Please include a Summary Why you need Christmas Assistance. Be as specific as possible so we can accurately evaluate your application.

Total Number in household

Are you employed? List Name of Employer and monthly income.

Photo ID

Proof of Address (utility bill, Lease, mortgage statement)