| This form must be mailed to Project Angel 311 Production Drive Avon, Indiana 46123 To be considered for assistance |
| Must be postmarked no later than December 1, 2010 |
| Please Print Clearly Date______________ |
| This form must be filled out in its entirety.. If approved you will be eligible for assistance for no more than three (3) consecutive years. You will be notified of the approval via your telephone number listed below. If you do not have a telephone, or if you haven't heard from us by December 1, 2010 it is your responsibility to contact us at 317-755-7780 and leave a message no later than December 1, 2010. You must include proof of residence with this application (copy of utitity bill with your name on it) to be considered for assistance. Failure to do so will result in application being denied and discarded. |
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| If approved you will be required to be home at the time of delivery. Please have someone there to help carry in food boxes. I give my permission for Project A.N.G.E.L. to share my name with any not-for-profit agency who gives Christmas assistance. I understand the Project A.N.G.E.L. Board of Directors will verify the information and if I purposely give false information I may be prosecuted. Must be signed and completed in Full to be considered for assistance. Signature____________________________________________________________ It is Project A.N.G.E.L.'s desire to get your child something he/she wishes for. Please indicate their "needs" also. Requests for Wii, PlayStation, IPod and other high priced items are not acceptable. There is no guarantee that you will receive assistance. |
| *Child's full name ____________________________ *Date of Birth__________ *sex____ *Pant size____________ *Shirt size____________ *Weight______________ *Age __________ *School Currently Attending ____________________________ Wish List ____________________________ ____________________________ ____________________________ |
| *Child's full name ____________________________ *Date of Birth__________ * sex_____ *Pant size____________ *Shirt size____________ *Weight______________ *Age _________ *School Currently Attending ____________________________ Wish List ____________________________ ____________________________ ____________________________ |
| *Child's full name ____________________________ *Date of Birth__________ *sex_____ *Pant size____________ *Shirt size____________ *Weight______________ *Age ___________ *School Currently Attending ____________________________ Wish List ____________________________ ____________________________ ____________________________ |
| *List all Household Members *Social Security Number *Relationship to *Amount TANF/Food Stamp Race head of household |
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| PROJECT A.N.G.E.L. SERVES HENDRICKS COUNTY ONLY. |
*Head of Household _________________________________*Address_________________________________ *City___________________ Place of Employment___________________________________ *Phone Number_______________ *Cell Number___________________*Date of Birth___________________________ *Spouse, (Father/Mother of children you wish to help)*Name_________________________*Address______________________ (If you are the Mother then we need the Father's name) (If different from Head of Household) |
| *Have you applied with or are you receiving Christmas help from: (Please circle all that apply) Shop with a cop Brownsburg Cheer Local Churches Schools Prison Assistance |
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| Please attach any information you think may be helpful in our application process. |
| Please feel free to give back to Project Angel by helping to sort cans at 311 Production Drive in Avon. You are welcome to bring your school age children. We will be sorting week day evenings from 6:00 p.m. to 8:00 p.m. |
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| I agree to help "pay forward" by donating my time to future volunteer efforts of Project A.N.G.E.L. You may contact me at _____________________________ |
| *YOU MUST HAVE LEGAL CUSTODY OF THE CHILDREN ON THIS APPLICATION. |