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Stuff the Bus

RETURN APPLICATION TO:

UNITED WAY OF LEE COUNTY PO BOX 3075 AUBURN, AL 36831

2019   SCHOOL SUPPLY APPLICATION

United Way desires for all children in Lee County to begin school with the tools to succeed. Our goal is for this program to assist families struggling to provide necessary school supplies. Applications are open to children attending school in Lee County. Applications must be received in the United Way office by July 8, 2019.  Supplies will be distributed based on need and the order in which applications are received.

 

If your application is accepted, you will be notified by phone call by July 26th. The phone call will be followed by a post card. The post card must be presented at the time of distribution. The distribution date and time will be listed on the postcard. United Way hopes to serve as many families with a demonstrated need for school supplies as possible.

Please complete both sides of application.  Thank you!

PARENT/ GUARDIAN INFORMATION (Required) 

 

Name: ________________________________Spouse/Significant Other_________________________

 

Mailing Address: ____________________________________________________________

 

City ___________________State________Zip Code___________  Phone: ______________________

 

Place of Employment __________________________Spouse Place of Employment _______________

                                  

                                                               FAMILY INFORMATION

            

 Number of family members in household: __________________________________

  

 Do you receive free or reduced school lunches? (Please Circle)        YES            NO

  

 Yearly Family Income Level: 

 ___ Up to $5,000   ___ $5,000-$15,000   ___$15,000-$25,000  ___$25,000-$35,000  ___Above $35,000

  

 

          YOUR COMMENTS WILL HELP US PLAN FOR FUTURE SCHOOL SUPPLY DRIVES

            

Why is the School Supply Drive important to you and your family? How does it        impact you and your child (ren)?       

 

 

 

 

 

 

 

Supplies available for K-12th grade.  Not available for Head Start, Preschool or College students.

If you do not need a backpack you may still receive the supplies just indicate so on the application.

 

Parent Signature __________________________   Date ________________________

 

STUDENT NAME & INFORMATION

 

Child Name: _________________________________       Entering Grade: ______________________

 

Age: ________________________________________        Gender:  _____________________________

 

School Name: _____________________________ My child needs (check one):    Backpack and supplies     Supplies only

 

 

 

Child Name: _________________________________       Entering Grade: ______________________

 

Age: ________________________________________        Gender:  _____________________________

 

School Name: _____________________________ My child needs (check one):    Backpack and supplies     Supplies only

 

 

 

Child Name: _________________________________       Entering Grade: ______________________

 

Age: ________________________________________        Gender:  _____________________________

 

School Name: _____________________________  My child needs (check one):    Backpack and supplies     Supplies only

 

 

Child Name: _________________________________       Entering Grade: ______________________

 

Age: ________________________________________        Gender:  _____________________________

 

School Name: _____________________________ My child needs (check one):    □ Backpack and supplies     □ Supplies only

 

Use additional sheet if necessary to list above information.

 

 

                                                        If you have questions please contact

                                                                United Way of Lee County

                                                                            334-745-5540

                                                       chandler@unitedwayofleecounty.com

                                                            www.unitedwayofleecounty.com