DEADLINE: APPLICATION AND PAPERWORK DUE IN: DATE: Nov 30th, 2017

Please return this application to:

Tri-Coastal Community Outreach

10520 Hwy 188, Grand Bay, AL 36541

(251) 865-9731 phone (251) 865- 2240 fax

E-mail carolyn@tricoastalcommunity.org


Received Date:_______________ Date Accepted/Denied:______________ Initials by: __________





PRESENTS


2016


“ ON WING OF DOVES”


Children's’ Christmas Assistance Program
( for children 16 and younger)

Date:_______________

Name: ________________________________________ Phone no.____________________

Current Address: _____________________________________________________________________________

Number of Household Members: ______ Household Income per mo.___________

 

Income and Address MUST BE VERIFIED.

Child(ren) Name Age Is this child disable

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

Requirement ** A BIRTH CERTIFICATE, CUSTODY PAPERS OR DOCUMENTATION THAT PROVES ALL Children listed ABOVE
LIVE IN YOUR HOUSEHOLD.