White Christmas Application

2006 WHITE CHRISTMAS GUIDELINES

1. ALL APPLICANTS ARE REQUIRED TO PROVIDE PROOF OF IDENTITY.

A PICTURE IDENTIFICATION WILL BE REQUIRED DURING THE APPLICATION PROCESS AND FOR PICKUP. This can be a driver’s license, employee identification or state issued identification card.

2. APPLICANTS MUST APPLY IN PERSON ON SATURDAY, NOVEMBER 11, 2006 BETWEEN 10:00 am and 4:00 pm AT THE ELLIJAY LIONS CLUB FAIRGROUNDS. Applicants must provide monthly income and expense information. Application Deadline is November 11, 2006.

3. All applicants will receive a letter stating the status of their request by mail. This will let you know if you have been approved and when to arrive for pick up. We will implement a NEW staggered pickup system to try to ease the traffic and wait times on distribution day. Your letter, if approved, will include a pickup voucher with a time span that we request you arrive in, if possible. If you cannot arrange to come during that time, you may arrive during the distribution times set for the day. For example if we request that you arrive between 10 am and 11 am and you cannot arrive until 11:30 that will be fine but to ease the backup of traffic we would appreciate your coming as close to your pickup time as possible. You can request a time during the application process. Be sure to bring your identification and voucher for pickup.

4. Applicants MUST agree that they will not attempt to obtain duplicate services for their holiday needs unless they are notified that their application has been denied by the White Christmas Program. This will ensure that more families can be assisted.

5. Applicants and their families MUST AGREE that they will NOT ATTEMPT TO RETURN GIFTS. EXCHANGES FOR LIKE KIND ITEMS ARE ACCEPTABLE BUT ABSOLUTLEY NO RETURNS ARE ALLOWED! If there are items that you do not wish to have your children receive, please make a note of it on your application. The exchange policy will be as follows: Clothing can be exchanged for clothing; toys/music/movies/games must be exchanged for other items of this kind. ABSOLUTLEY NO ITEMS CAN BE RETURNED FOR CASH OR FOR ITEMS OTHER THAN THOSE INTENDED FOR THE CHILDREN.

6. Applicants should understand that we provide for children 16 years old and younger. We do request a list of preferences along with size if clothing is requested so that we can better provide the items your children prefer.

7. Applicants should mark if they would like to receive a box of food on the application so that we can plan accordingly. Any family that is approved for assistance is eligible for food, however, you do not have to receive food if you do not need or want it. The food portion does not affect the gift portion of the assistance in any way. It is simply an optional portion of the program.

8. White Christmas Distribution will be on Saturday, December 16^th during the hours of 9:00 am to 1:00 pm. You will be assigned an hour of arrival time unless you request a specific time on your application.

2006 WHITE CHRISTMAS APPLICATION

Applicant Name:______________________________ Age:______ D.O.B.___________

Photo Id Type:__________________ Number______________ Phone #_____________

Mailing Address:_____________________________City____________GA Zip_______

Spouse’s Name:_____________________________ Age:_____ D.O.B.______________

Photo Id Type:__________________ Number______________ Phone #_____________

Applicant Employed?____________________ Spouse Employed?__________________

Applicant Employer: ____________________ Spouse Employer:___________________

How Long?____________________________ How Long?________________________

Other Adults in Household?______Name(s)/Relationship_________________________

INCOME INFORMATION

Wages $___________ per wk or mth? ______ Wages $__________ per wk or mth?____

Other Income $ ________type ____________ Other Income $_________type_________

SSI/Worker Comp/ Disability_____________ SSI/Worker Comp/Disability __________

Child Support/Alimony __________________ Child Support/Alimony ______________

Food Stamps/Unemployment ______________ Food Stamps/Unemployment _________

TOTAL HOUSEHOLD INCOME: $______________ per__________

HOUSEHOLD EXPENSES (Monthly)

Rent/Mortgage: $ ________________ Electricity $ __________ Water $ ___________

Groceries $ _____________ Phone $ __________ Medical $_______ Auto $_________

Other (list amount and type) ________________________________________________

TOTAL EXPENSES: $_________________ per month

I/We,_________________________________________, authorize the Gilmer County Department of Family and Children Services to release information concerning my family and household situation to other community organizations, such as the White Christmas Committee, in being referred for Christmas gifts and food. My/Our signature(s) signify that we (applicant and /or spouse) will not attempt to obtain duplicate services through Community Action or other charitable organizations for my/our Christmas Holiday needs unless notified that we will not be assisted through the White Christmas Program. I/We certify that all information on this application is true and complete to the best of my/our knowledge. I/We have received, read and understand the guidelines of the White Christmas Program. I/We understand that if found to have violated these guidelines, that my family will no longer be eligible for assistance now or in the future.

Signature:___________________________________ Date:__________________

NEED INFORMATION

Do you need assistance with… FOOD Yes_____ No_____ (This does not affect eligibility)

CLOTHING Yes_____ No_____ TOYS Yes_____ No_____

OTHER Yes_____ No_____ Explain__________________________________

__________________________________________________________________

Have you had any catastrophic events or unusual circumstances recently?______________

What type?_______________________________________________________________

Do you have any special needs?______ What are they?____________________________

________________________________________________________________________

Would you like a specific time for pickup on December 16^th? ______ What Time?______

Have you applied for assistance anywhere else?________

Do you have any dealings with DFACS?_____ or Family Connections?_____

How many children live with you all of the time?__________________

Do you have children that live with you only for weekends or holidays?______

Do you need assistance with gifts for these children?____

How many?_______ Names, ages, etc.___________________________________

___________________________________________________________________

CHILDREN’S INFORMATION

ONLY THOSE THAT LIVE WITH YOU ALL OF THE TIME

CHILD 1. Name: ___________________ Age:_______ Girl or Boy (circle one)

If item not needed put “No” in size area – if item is needed put size in area Clothing Sizes: Pants: ____ Shirts:____ Shoes:____ Underwear:____ Coat:____ Pajamas:____ Socks:____ Hat:____ Gloves:____ Other:____________________

Please list specific music artists, toys, games, characters, videos (Video or DVD) etc. for the Toy/Gift Requests:__________________________________________

____________________________________________________________________________________________________________________________________