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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?