Organization Name *
Organization Type *
Government
Clothing/Basic Needs Assistance
Elementary/Middle School
Elementary School
Preschool/Head Start
High School
Homeless Aid
Library
Middle School
First Name *
Last Name *
Job Title *
Email *
Phone *
Organization Website *
What is the mission of your organization? *
How many students are enrolled at your school? *
What grade levels do you serve? *
How many children under third grade does your organization serve? *
What is the percentage of students receiving free and reduced meals? *
Amount of shoes needed (Please enter a number) *
Would you allow volunteers inside the school to gift shoes to the students? *
Yes
No
Please describe the need of those you serve *
Please describe what new shoes would mean to those you serve *
Shipping Address *
Address Two
City *
State / Province *
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip / Postal Code *
Country *
United States
Canada
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