Organization Name *
Organization Type *
Government
Clothing/Basic Needs Assistance
Elementary/Middle School
Elementary School
Preschool/Head Start
High School
Homeless Aid
Library
Middle School
Church/Faith Based
Application Type *
Coat Application
Shoe Application
Coat & Shoe Application
First Name *
Last Name *
Job Title *
Email *
Phone (Please enter a number) *
Organization Website *
What is the mission of your organization? *
What other resources do you provide children? *
How many students are enrolled at your school? (Please enter a number) *
What age does your organization serve? *
What grade levels do you serve? *
How many children from pre-k through 5th grade does your organization serve? *
How many children through 2nd grade does your organization serve? *
What percentage of students receive free and reduced meals? (Please enter a number) *
Number of coats needed (Please enter a number) *
Number of shoes needed (Please enter a number) *
Would you be able to host a 4-hour event in a gym, large space, or outdoor recreation area? *
Yes
No
Would you allow up to 50 volunteers inside the building to gift coats/shoes to the children? *
Yes
No
Does your school or organization host summer camps or recreational activities? *
Yes
No
Please describe the need of those you serve *
Please describe what a new coat and/or pair of shoes would mean to those you serve *
Organization Address *
Address Two
City *
State / Province *
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip / Postal Code *
Country *
United States
Canada
Please select all that apply: *
My organization is led by a BIPOC
We serve primarily minority children
Our organization revenue is less than $500,000
We serve vulnerable populations
None of these apply to my organization
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