Kids Coats Intake Form

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

You may also print out the form HERE and submit it to the Parma Area Family Collaborative office.

Online Intake Form (Submit 1 form PER CHILD)


Division of Child and Family Services Involvement: YesNo

Do you receive any of the following benefits?:
Food StampsMedicaidCash Assistance

Ongoing Case Worker:

Your Name (required)

Address (required)

Zip (required)

Phone (required)

Monthly Income (required)

Your Email (required)

Gender (required)
MaleFemale

Race (required)

DOB (required)

Marital Status (required)

Last 4 digits of SS# (required)

Child Information

Name

Gender MaleFemale

Size

Size for Child or Adult ChildAdult

DOB
Grade
Race

Circumstances why your family is in need of winter coat/s?

Do you have transportation?

Do you qualify for one of the following?
Free LunchReduced Lunch

Upcoming Events

Oct
25
Thu
9:00 am Community Collab Meeting – Topic... @ Hanna Building
Community Collab Meeting – Topic... @ Hanna Building
Oct 25 @ 9:00 am – 10:30 am
Join us for breakfast, discussion and table talk around the CASA program here in Cuyahoga County.  This monthly program is free as always, light breakfast provided and you are always welcome to bring a friend[...]
2:00 pm Clothing Center @ Parma Area Family Collaborative
Clothing Center @ Parma Area Family Collaborative
Oct 25 @ 2:00 pm – 4:00 pm
If the Parma City Schools are closed for inclement weather, the Family Collaborative will be closed.
Nov
1
Thu
2:00 pm Clothing Center @ Parma Area Family Collaborative
Clothing Center @ Parma Area Family Collaborative
Nov 1 @ 2:00 pm – 4:00 pm
If the Parma City Schools are closed for inclement weather, the Family Collaborative will be closed.
Nov
8
Thu
2:00 pm Clothing Center @ Parma Area Family Collaborative
Clothing Center @ Parma Area Family Collaborative
Nov 8 @ 2:00 pm – 4:00 pm
If the Parma City Schools are closed for inclement weather, the Family Collaborative will be closed.
2:30 pm Mobile Food Pantry @ Parma Area Family Collaborative
Mobile Food Pantry @ Parma Area Family Collaborative
Nov 8 @ 2:30 pm – 4:30 pm
 
Nov
15
Thu
9:00 am 3rd Thursday! Community Collab M... @ Hanna Building
3rd Thursday! Community Collab M... @ Hanna Building
Nov 15 @ 9:00 am – 10:30 am
Join us for a light breakfast, networking and interesting discussion as we serve families in our area.  Share your program highlights and get to know other stakeholders in our corner of the county.  All welcome!