Holiday Assistance Online Form

The Holiday Assistance Application is now closed. You may still complete the application below, but please know you will be placed on a waiting list. Completing an application does not guarantee supports or services.

Please submit the following Intake Form for so that we may determine your eligibility for the HOLIDAY ASSISTANCE program.

Submit one application for each eligible child.

Personal Info

First Name (required)

Last Name (required)

Last 4 digits of SS# (required)

Address (required)

Zip (required)

Phone (required)

Your Email (required)

Gender (required)
Race (required)

DOB (required)

Monthly Income (required)

Please complete the following information for each eligible child in your family.

Child Info



Gender MaleFemale



Interests, Hobbies, Characters/Teams

Special Requests

PLEASE NOTE: This application does not guarantee Holiday Assistance. We will notify you if your application has been accepted.

Please review all information before submitting!