Christmas Caring Application 2023 applications are closed. If you have are facing a financial crisis and need assistance, please call (901) 465-3802 x 224 or email casemanager@fayettecares.org. Fill out one form per household (physical address). Please list everyone in the household.Applicant Name First Last Address Street Address Mailing Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Sex/Gender Identity Date of Birth MM slash DD slash YYYY AgeSocial Security Number RaceWhiteBlackMixedAmerican IndianPacific IslanderHispanic or Latino Yes No Families First $SSI $SSDI $Child Support $Other Income $# of Adults# of Children (under 18)Tell us the number of kids in your home. If you have children 12 and under, you'll complete a wish list below. Total # in HouseholdDo not include food stamps as incomeNames and Monthly Income Information for Everyone in HouseholdPeople listed should match food stamp letter. Do not include food stamps as income#1 Household Member Name First Last Relationship to Applicant Sex/Gender Identity Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AgeSocial Security Number RaceWhiteBlackMixedAmerican IndianPacific IslanderHispanic or Latino Yes No Families First $SSI $SSDI $Child Support $Other Income $#2 Household Member Name First Last Relationship to Applicant Sex/Gender Identity Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AgeSocial Security Number RaceWhiteBlackMixedAmerican IndianPacific IslanderHispanic or Latino Yes No Families First $SSI $SSDI $Child Support $Other Income $#3 Household Member Name First Last Relationship to Applicant Sex/Gender Identity Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AgeSocial Security Number RaceWhiteBlackMixedAmerican IndianPacific IslanderHispanic or Latino Yes No Families First $SSI $SSDI $Child Support $Other Income $#4 Household Member Name First Last Relationship to Applicant Sex/Gender Identity Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AgeSocial Security Number RaceWhiteBlackMixedAmerican IndianPacific IslanderHispanic or Latino Yes No Families First $SSI $SSDI $Child Support $Other Income $#5 Household Member Name First Last Relationship to Applicant Sex/Gender Identity Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AgeSocial Security Number RaceWhiteBlackMixedAmerican IndianPacific IslanderHispanic or Latino Yes No Families First $SSI $SSDI $Child Support $Other Income $Total Household Income Per MonthRent/Mortgage Per MonthFood Stamp AmountProof of IncomeMax. file size: 32 MB.SSI, SSD, paystub, etc.Proof of School EnrollmentMax. file size: 32 MB.Progress report from school portal.DHS Verification (if receiving food stamps)Max. file size: 32 MB.Proof of Residence*Max. file size: 32 MB.Mail dated within 30 days including utility, phone, or internet bill.Wish List for Gifts (children 12 and under)Typical gift donations range from $10-$50. Submitting this form does not guarantee gifts.#1 Child's Name First Last Internal Code (Fayette Cares use only)Sex/Gender Identity AgeShoe SizeShirt Size Pant Size Favorite Color BicycleMarking Yes does not guarantee a bicycle will be donated/provided. Yes No Height in Inches (for bike only) InterestsList gifts they might enjoy#2 Child's Name First Last Internal Code (Fayette Cares use only)Sex/Gender Identity AgeShoe SizeShirt Size Pant Size Favorite Color BicycleMarking Yes does not guarantee a bicycle will be donated/provided. Yes No Height in Inches (for bike only) InterestsList gifts they might enjoy#3 Child's Name First Last Internal Code (Fayette Cares use only)Sex/Gender Identity AgeShoe SizeShirt Size Pant Size Favorite Color BicycleMarking Yes does not guarantee a bicycle will be donated/provided. Yes No Height in Inches (for bike only) InterestsList gifts they might enjoy#4 Child's Name First Last Internal Code (Fayette Cares use only)Sex/Gender Identity AgeShoe SizeShirt Size Pant Size Favorite Color BicycleMarking Yes does not guarantee a bicycle will be donated/provided. Yes No Height in Inches (for bike only) InterestsList gifts they might enjoy#5 Child's Name First Last Internal Code (Fayette Cares use only)Sex/Gender Identity AgeShoe SizeShirt Size Pant Size Favorite Color BicycleMarking Yes does not guarantee a bicycle will be donated/provided. Yes No Height in Inches (for bike only) InterestsList gifts they might enjoy#6 Child's Name First Last Internal Code (Fayette Cares use only)Sex/Gender Identity AgeShoe SizeShirt Size Pant Size Favorite Color BicycleMarking Yes does not guarantee a bicycle will be donated/provided. Yes No Height in Inches (for bike only) InterestsList gifts they might enjoyVerification and Permission* I verify that this information is correct to the best of my knowledge. I give permisison to fayette Cares ot contact the Department of Human Service or other agencies to verify information on this application.Application with Fayette Cares does not guarantee that you will receive food or toys through the Christmas Caring program. Fayette Cares does not discriminate against any person because of race, color, sexual orientation, gender identity, family identification, familial status or national origin. The information collected is for Fayette Cares use only, and will be used to gather statistical data, to better serve the community with social services.Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
