Whitehall Clothing Application

Parent / Guardian Information

Is this your first time receiving help from Charity Newsies? *

Yes

Parent/Guardian – First Name. Must match ID. *

Name may only contain letters, numbers or spaces.

Parent/Guardian – Last Name. Must match ID. *

Name may only contain letters, numbers or spaces.

Do you currently live in a homeless or emergency shelter? *

Yes

Name of Shelter *

Parent/Guardian – Address: Please do NOT use the # sign. *

Address may only contain letters, numbers or spaces.

City *

County *

MUST be resident of Franklin County

Invalid County message *

State

Zip Code *

Parent/Guardian – 10 Digit Phone Number *

Confirmation reminder Text 48 hours prior to appointment *

Yes

Parent/Guardian – Email Address *

Enter Email

Confirm Parent/Guardian – Email Address *

Confirm Email Address

Parent/Guardian – Birth Date mm/dd/yyyy *

Parent/Guardian – Last Four Digits of Social Security # or TFIN *

PLEASE CHECK SOCIAL SECURITY CARD!!

Marital Status *

Relationship to Child(ren) *

Social Worker Name *

Name may only contain letters, numbers or spaces.

School Delivery Location *

Child(ren) Information

Child – First Name *

Child – First Name May only contain letters, numbers or spaces.

Child – Last Name *

Child – Last Name May only contain letters, numbers or spaces.

Child – Birth Date mm/dd/yyyy *

Child – Birth Date

Child – Age

Child – Last Four Digits of Social Security Number *

Child – Last 4 digits of SSN

Gender for Clothing *

Male

Female

Gender

Grade Level *

Grade Level

Name of School

Uniform Voucher

Shirt Voucher

Shirt is purchased from school

Dress Code

No Dress Code

Grade Specific colors.

White Shirt

Black Shirt

Purple Shirt

Red Shirt

Maroon Shirt

Hunter Green Shirt

Gray Shirt

Navy Shirt

Light Blue Shirt

Blue Shirt

Yellow Shirt

Any Color Polo Shirt

Khaki Pants

Black Pants

Navy Pants

Continue with this school choice (Uniform Voucher)

Yes