School Supply Assistance

Please submit the following online application so that we may determine your eligibility for the SCHOOL SUPPLY program.

IMPORTANT: Be accurate in the information you provide. Also a regularly checked email is needed.

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

Application Form

Parent/Guardian First Name (required)

Parent/Guardian Last Name (required)

Email (required)

Address (required)

Phone (required)

Alternate Phone

Last 4 digits of SS# (required)

Parent DOB (required)

****PLEASE LIST SCHOOL AND GRADE FOR 2018/2019****

School Age Child/ren

Child #1
Name

Gender MaleFemale

School
Grade

Child #2
Name

Gender MaleFemale

School
Grade

Child #3
Name

Gender MaleFemale

School
Grade

Child #4
Name

Gender MaleFemale

School
Grade

Child #5
Name

Gender MaleFemale

School
Grade

Circumstances why your family is in need of school supply assistance? (required)

Do you receive any of the following benefits? (required):
UnemploymentMedicaidFood AssistanceCash AssistanceFree LunchReduced Lunch

Monthly Income (required)