VAC 2020 Christmas Application

BEFORE COMPLETING THE APPLICATION ANSWER THESE QUESTIONS

1. Do you live in Gordon County? *
2. Do your school aged child(ren) attend school in Gordon County? *
3. Does the child or children you are seeking assistance for live with you full time? *
4. Does your household fall at or below 140% of Federal Poverty Income Guidelines?  Household income includes gross income (before taxes and other withholding) for all adults living in the home.  (SEE CHART BELOW)

# of Individuals in Home Monthly Income     # of Individuals in Home Monthly Income
1  $           1,489     6  $            4,102
2  $           2,011     7  $            4,625
3  $           2,534     8  $            5,147
4  $           3,057     9  $            5,777
5  $           3,579     10  $            6,407
 *
5. Have you completed a virtual class? *

Save & Return

Use an account to return to saved work.

VAC 2020 Christmas Survey

Household and Family Questions: Answer for everyone living in your home.

Did anyone in your home lose their job due to Covid-19? *
Was anyone in your home temporarily out of work due to Covid-19? *
Did anyone in your home draw un-employment benefits due to Covid-19? *
Do you receive food from local food banks? *
Did you receive assistance from Tallatoona to help with heating or cooling? *
Does anyone in your household draw disability or social security benefits? *
Do your child(ren) receive free or reduced breakfast or lunches at school? *
Do you receive financial help from someone not living in your home? *
Have you moved in the last year? *

Individual Questions: Answer about yourself.

Did you receive Christmas help from the VAC last year? *
Did you receive Christmas help from Toys for Tots last year? *
Did anyone else help you with Christmas for your kids last year? *
Do you plan to purchase anything for your kids this Christmas? *
Do you give your kids their Christmas presents before Christmas Eve? *
Have you ever been homeless? *
Do you live with anyone other than your children and partner/spouse? *
Do you have difficulty providing food for your family? *
Do you have difficulty keeping your rent or mortgage paid? *
Did you receive a stimulus check this year? *

Parent/Guardian 1:



Does this phone have text capabilities? *

Is there another parent/guardian living in the houshold? *

Parent/Guardian 2:



PARENT/GUARDIAN STATEMENT OF AGREEMENT:

By signing this application you are confirming that you have no way to provide Christmas for your children and have provided proof of income for all adults living in your household. By accepting Christmas assistance from the VAC, you agree to not seek or receive Christmas assistance from ANY OTHER AGENCY OR ORGANIZATION. Failure to comply with any part of the VAC Christmas Assistance Agreement guidelines may result in your removal from this program and denied participation in the future. *
clear

Children Information

Children Information: (Child #1)


Child #1 Shirt Size: *
Child #1 Pants/Skirt Size: *
Child #1 Shoe Size: *

Children Information: (Child #2)


Child #2 Shirt Size: *
Child #2 Pants/Skirt Size: *
Child #2 Shoe Size: *

Children Information: (Child #3)


Child #3 Shirt Size: *
Child #3 Pants/Skirt Size: *
Child #3 Shoe Size: *

Children Information: (Child #4)


Child #4 Shirt Size: *
Child #4 Pants/Skirt Size: *
Child #4 Shoe Size: *

Children Information: (Child #5)


Child #5 Shirt Size: *
Child #5 Pants/Skirt Size: *
Child #5 Shoe Size: *

Children Information: (Child #6)


Child #6 Shirt Size: *
Child #6 Pants/Skirt Size: *
Child #6 Shoe Size: *

Children Information: (Child #7)


Child #7 Shirt Size: *
Child #7 Pants/Skirt Size: *
Child #7 Shoe Size: *

Children Information: (Child #8)


Child #8 Shirt Size: *
Child #8 Pants/Skirt Size: *
Child #8 Shoe Size: *
Powered byFormsite