South Belt’s Christmas program application form

Your name:


Spouse's name:


Your home address:


Zip code:


Phone #:


Alternate phone#:


Number of children:


I need help for the holidays because:


Where else have you applied for Christmas assistance?:


Have you ever applied for or received help from the Leader before?


List child's first and last name, age, gender and school they attend.
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Applicants must live in a South Belt area zip code. Proof of address must be shown – such as a utility bill, Texas driver's license, etc. Leader must verify that help is needed...(minister, school principal or nurse, social services, etc.) Please give name and phone number:


Did your residence have flood damage due to hurricane Harvey?