Christmas In Coweta Application

Christmas In Coweta

Coweta County Residency Verification

Two items from the list below are required for Verification:

1) Photo ID with Coweta County address (e.g., Driver's license, Real ID)

2) Current Utility bill (e.g., water, gas, electric, internet, garbage)

3) Rental lease, mortgage document, property tax document, rental receipt, HUD statement

4) Documents listing Coweta County address (e.g., Medicare/Medicaid, Disability, WIC, Voter registration card), Vehicle registration card with Coweta County address

Coweta County Residency Verification Document #1 *

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Coweta County Residency Verification Document #2 *

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Parent/Guardian Full Name *

First

Middle

Last

Relationship to the child(ren) *

Birthday *

Marital Status *

Phone Number *

Email *

Confirm Email

Is there another adult in your house who has responsibility for the child/children form whom you are requesting assistance? *

Parent/Guardian #2 Name: *

First

Last

Relationship to the child(ren) *

Phone Number *

Housing

Housing type *

Rent
Own
Other

Do you live in government-subsidized housing or receive funds to pay for housing?

Describe your housing situation *

Address *

Address Line 1

City

State

Zip Code

Must reside in Coweta County GA

Alternate Contact

This is a trusted individual we can contact if you cannot be reached.

First Name *

Last Name *

Alternate Contact Phone Number *

Other Household information

Military/Reserves- Has anyone in your household ever served in the U.S. Military or the Military Reserves? *

No
Yes, Mother of children
Yes, Father of children
Yes, both parents of children
Yes, Legal guardian of the children

Do you have DD214 Discharge papers from the Military?

Do you have transporation? *

I have a vehicle
I have a trusted person I can ask for a ride
I do not have a vehicle or anyone I can ask for a ride
I used a transportation service

Do you have a church you regularly attend? *

What is the name of the church *

How did you hear about Christmas in Coweta? *

BTG
Coweta Pregnancy Center
Families Helping Families
Elevate Coweta
Flyer
School Counselor
i58
Back Pack Buddies
Family Patterns Matter
Church
Coweta Force
Other

Income

What are your sources of income? *

e.g., Job, SS, SNAP, Unemployment, Child Support, no income, etc.

Total (all sources of income) *

Is this Income total *

Weekly
Monthly
Yearly

CHILDREN

Do NOT complete this application and include children under your name on behalf of another family member or friend.

The children you list on this application must reside in your home.

If the child is 18 years old, they must still be enrolled in High School.

. *

I agree

How many eligible children in your home?

The number chosen will determine how many children's information sections will show.

If you have more than 6 children, we will email you a link to add those additional children to this application.

Do you have additional children you need to add to your application? *

If you have more than 6 eligible children, please select YES, and we will email you a link to add those additional children to your application.

List your children in oldest to youngest order.

Child 1: Full Name as shown on Birth Certificate *

First

Middle

Last

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 1: Document *

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Child 1: Birthday *

Child 1:Race Ethnicity *

Asian American
Black American
Hispanic American
Multiracial
Native American
White

Child 1: Age *

Child 1: Gender *

Girl
Boy

School Information

Child 1: School type *

Not school-aged
Preschool
Elementary
Middle
High
Homeschool/online school

What School is Child 1 attending? *

Child 1 grade? *

Homeschool/Online curriculum level Child 1 *

Elementary
Middle
High

Child 1: Shirt, Pant, Shoe Sizes and needs

CLOTHING type for Child 1: *

Baby
Toddler
Kids
Junior Girls
Women
Men

Child 1: SHIRT size *

Child 1: PANT size *

SHOE type for Child 1: *

Baby
Toddler
Kids
Women
Men

Child 1: SHOE size *

Child 1: Clothing/Shoe needs *

Clothing/Shoe need examples:

shirts (T-shirt, long-sleeve), jeans (flare, skinny), athletic wear

sneakers with velcro strap or boots or slides

Child 1: Other Needs *

Child 1: Favorite color *

Child 1: Favorite things *

Child 1: Interests *

Does Child 1 play a musical instrument? *

Does Child 1 own their own instrument? *

Does Child 1 play in the band at school? *

Name of student's music teacher? *

What instrument would Child 1 like to own? *

Child 1: Something to Read *

Activity books, ABCs, Colors, Shapes, Numbers, Bedtime stories, Favorite character books.

Chapter books (list book title), Graphic Novels (list book title), Grade level books, Character books (list Favorite).

Anime (list book title), Bible/Daily Devotionals, Fiction novels (list book title), Gaming magazines, History, learning a skill book (list skill), Mystery novels (list book title), Self-care, Sports.

Child 1: Wishlist *

Activity boards, Building blocks, balls, cars, trucks, tractors, costume/dress up sets, Disney toys (list character), baby dolls, coloring books, favorite character toys (list character), learning toys, musical toys, Play-Doh, stuffed animals, outdoor toys (list type).

Action figures (list characters), Art supplies (list type), Barbies, board games (list type), Craft sets, cars/trucks, Disney toys/dolls (list character), dress-up costumes, Character toys (list characters), Hot Wheels/Matchbox, jewelry/bracelet making kits, Journals, Legos, Nerf toys, play tent/forts, RC cars, sport balls (list type), Spa/Nail kits, stuffed animals, outdoor toys (list type).

Art supplies (list type), Bath/body products (list type), blanket, Bluetooth speakers, board games (list type), fairy lights/LED lights, jewelry/bracelet making kits, Journals, Legos, Make up (list brand/type), Movie ticket, perfume/cologne, room decor (list theme), Spa/Nail kits, sport balls (list type), Sports memorabilia (list Team), tumbler cups, wallet/purse.

Child 2: Information

Child 2: Full Name as shown on Birth Certificate *

First

Middle

Last

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 2: Document *

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Child 2: Birthday *

Child 2: Race Ethnicity *

Asian American
Black American
Hispanic American
Multiracial
Native American
White

Child 2: Age *

Child 2: Gender *

Girl
Boy

Child 2: School Information

Child 2: School type *

Not school-aged
Preschool
Elementary
Middle
High
Homeschool/online school

What School is Child 2 attending? *

Child 2 Grade: *

Homeschool/Online school curriculum level Child 2 *

Elementary
Middle
High

Child 2: Shirt, Pant, Shoe size and needs

CLOTHING type for Child 2: *

Baby
Toddler
Kids
Junior Girls
Women
Men

Child 2: SHIRT size *

Child 2: PANT size *

SHOE type for Child 2: *

Baby
Toddler
Kids
Women
Men

Child 2: SHOE size *

Child 2: Clothing/Shoe needs *

Clothing/Shoe need examples:

shirts (T-shirt, long-sleeve), jeans (flare, skinny), athletic wear

sneakers with velcro strap or boots or slides

Child 2: Other Needs *

Child 2: Favorite color *

Child 2: Favorite things *

Child 2: Interests *

Does Child 2 play a musical instrument? *

Does Child 2 own their own instrument? *

Does Child 2 play in the band at school? *

Name of student's music teacher? *

What instrument would Child 2 like to own? *

i.e., Flute, Trumpet, Clarinet, Trombone, Guitar, keyboard

Child 2: Something to Read *

Activity books, ABCs, Colors, Shapes, Numbers, Bedtime stories, Favorite character books.

Chapter books (list book title), Graphic Novels (list book title), Grade level books, Character books (list Favorite).

Child 2: Wishlist *

Child 3: Information

Child 3: Full Name as shown on Birth Certificate *

First

Middle

Last

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 3: Document *

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Child 3: Birthday *

Child 3: Race Ethnicity *

Asian American
Black American
Hispanic American
Multiracial
Native American
White

Child 3: Age *

Child 3: Gender *

Girl
Boy

Child 3: School Information

Child 3: School type *

Not school-aged
Preschool
Elementary
Middle
High
Homeschool/online school

What school is Child 3 attending? *

Child 3 Grade: *

Homeschool/Online school curriculum level Child 3 *

Elementary
Middle
High

Child 3: Shirt, Pant, Shoe Size and needs

CLOTHING type for Child 3? *

Baby
Toddler
Kids
Juniors
Women
Men

Child 3: SHIRT size *

Child 3: PANT size *

SHOE type for Child 3: *

Baby
Toddler
Kids
Women
Men

Child 3: SHOE size *

Child 3: Clothing/Shoe needs *

Clothing/Shoe need examples:

shirts (T-shirt, long-sleeve), jeans (flare, skinny), athletic wear

sneakers with velcro strap or boots or slides

Child 3: Other Needs *

Child 3: Favorite color *

Child 3: Favorite things *

Child 3: Interests *

Does Child 3 play a musical instrument? *

Does Child 3 own their own instrument? *

Does Child 3 play in the band at school? *

Name of student's music teacher? *

What instrument would Child 3 like to own? *

i.e., Flute, Trumpet, Clarinet, Trombone, Guitar, keyboard

Child 3: Something to Read *

Activity books, ABCs, Colors, Shapes, Numbers, Bedtime stories, Favorite character books.

Chapter books (list book title), Graphic Novels (list book title), Grade level books, Character books (list Favorite).

Child 3: Wishlist *

Child 4: Information

Child 4: Full Name as shown on Birth Certificate *

First

Middle

Last

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 4: Document *

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Child 4: Birthday *

Child 4: Race Ethnicity *

Asian American
Black American
Hispanic American
Multiracial
Native American
White

Child 4: Age *

Child 4: Gender *

Girl
Boy

Child 4: School Information

Child 4: School type *

Not school-aged
Preschool
Elementary
Middle
High
Homeschool/online school

What School does Child 4 attend? *

Child 4 Grade: *

Homeschool/Online school curriculum level Child 4 *

Elementary
Middle
High

Child 4: Shirt, Pant, Shoe Size and needs

CLOTHING type for Child 4: *

Baby
Toddler
Kids
Junior Girls
Women
Men

Child 4: SHIRT size *

Child 4: PANT size *

SHOE type for Child 4: *

Baby
Toddler
Kids
Women
Men

Child 4: SHOE size *

Child 4: Clothes/Shoe needs *

Clothes/Shoe need examples:

shirts (T-shirt, long-sleeve), jeans (flare, skinny), athletic wear

sneakers with velcro strap or boots or slides

Child 4: Other Needs *

Child 4: Favorite color *

Child 4: Favorite things *

Child 4: Interests *

Does Child 4 play a musical instrument? *

Does Child 4 own their own instrument? *

Does Child 4 play in the band at school? *

Name of student's music teacher? *

What instrument would Child 4 like to own? *

i.e., Flute, Trumpet, Clarinet, Trombone, Guitar, keyboard

Child 4: Something to Read *

Activity books, ABCs, Colors, Shapes, Numbers, Bedtime stories, Favorite character books.

Chapter books (list book title), Graphic Novels (list book title), Grade level books, Character books (list Favorite).

Child 4: Wishlist *

Child 5: Information

Child 5: Full Name as shown on Birth Certificate *

First

Middle

Last

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 5: Document *

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Child 5: Birthday *

Child 5: Race Ethnicity *

Asian American
Black American
Hispanic American
Multiracial
Native American
White

Child 5: Age *

Child 5: Gender *

Girl
Boy

Child 5: School Information

Child 5: School type *

Not school-aged
Preschool
Elementary
Middle
High
Homeschool/online school

What School does Child 5 attend? *

Child 5 Grade: *

Homeschool/Online school curriculum level Child 5 *

Elementary
Middle
High

Child 5: Shirt, Pant, Shoe Sizes and needs

CLOTHING type for Child 5: *

Baby
Toddler
Kids
Women
Men

Child 5: SHIRT size *

Child 5: PANT size *

SHOE type for Child 5: *

Baby
Toddler
Kids
Women
Men

Child 5: SHOE size *

Child 5: Clothing/Shoe needs *

Clothing/Shoe need examples:

shirts (T-shirt, long-sleeve), jeans (flare, skinny), athletic wear

sneakers with velcro strap or boots or slides

Child 5: Other needs *

Child 5: Favorite color *

Child 5: Favorite things *

Child 5: Interests *

Does Child 5 play a musical instrument? *

Does Child 5 own their own instrument? *

Does Child 5 play in the band at school? *

Name of student's music teacher? *

What instrument would Child 5 like to own? *

i.e., Flute, Trumpet, Clarinet, Trombone, Guitar, keyboard

Child 5: Something to Read *

Activity books, ABCs, Colors, Shapes, Numbers, Bedtime stories, Favorite character books.

Chapter books (list book title), Graphic Novels (list book title), Grade level books, Character books (list Favorite).

Child 5: Wishlist *

Child 6: Information

Child 6: Full Name as shown on Birth Certificate *

First

Middle

Last

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 6: Document *

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Child 6: Birthday *

Child 6: Race Ethnicity *

Asian American
Black American
Hispanic American
Multiracial
Native American
White

Child 6: Age *

Child 6: Gender *

Girl
Boy

Child 6: School *

Not school-aged
Preschool
Elementary
Middle
High
Homeschool/online school

What School does Child 6 attend? *

Child 6 Grade: *

Homeschool/Online school curriculum level Child 6 *

Elementary
Middle
High

Child 6: Shirt, Pant, Shoe Sizes and needs

CLOTHING type for Child 6: *

Baby
Toddler
Kids
Junior Womens
Women
Men

Child 6: SHIRT size *

Child 6: PANT size *

SHOE type for Child 6: *

Baby
Toddler
Kids
Women
Men

Child 6: SHOE size *

Child 6: Clothing/Shoe needs *

Clothing/Shoe need examples:

shirts (T-shirt, long-sleeve), jeans (flare, skinny), athletic wear

sneakers with velcro strap or boots or slides

Child 6: Other needs *

Child 6: Favorite color *

Child 6: Favorite things *

Child 6: Interests *

Does Child 6 play a musical instrument? *

Does Child 6 own their own instrument? *

Does Child 6 play in the band at school? *

Name of student's music teacher? *

What instrument would Child 6 like to own? *

i.e., Flute, Trumpet, Clarinet, Trombone, Guitar, keyboard

Child 6: Something to Read *

Activity books, ABCs, Colors, Shapes, Numbers, Bedtime stories, Favorite character books.

Chapter books (list book title), Graphic Novels (list book title), Grade level books, Character books (list Favorite).

Child 6: Wishlist *

Parent requests and Agreement

(copy) Full Number

Other requests, prayer requests, or situations?

Application Agreement *

I agree

I agree my information will be shared with sponsors, schools, churches, and other organizations. I agree not to apply with any other Christmas assistance organization. If any children on this application are found to be on another list, that child will no longer be eligible to receive assistance.

Email Address

Phone Number

Our Location

Christmas In Coweta Application

Christmas In Coweta

Coweta County Residency Verification

Two items from the list below are required for Verification:

1) Photo ID with Coweta County address (e.g., Driver's license, Real ID)

2) Current Utility bill (e.g., water, gas, electric, internet, garbage)

3) Rental lease, mortgage document, property tax document, rental receipt, HUD statement

4) Documents listing Coweta County address (e.g., Medicare/Medicaid, Disability, WIC, Voter registration card), Vehicle registration card with Coweta County address

Housing

Alternate Contact

Other Household information

Income

CHILDREN

Do NOT complete this application and include children under your name on behalf of another family member or friend.

The children you list on this application must reside in your home.

If you have more than 6 children, we will email you a link to add those additional children to this application.

If you have more than 6 eligible children, please select YES, and we will email you a link to add those additional children to your application.

List your children in oldest to youngest order.

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

School Information

Child 1: Shirt, Pant, Shoe Sizes and needs

Clothing/Shoe need examples:

Child 2: Information

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 2: School Information

Child 2: Shirt, Pant, Shoe size and needs

Clothing/Shoe need examples:

Child 3: Information

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 3: School Information

Child 3: Shirt, Pant, Shoe Size and needs

Clothing/Shoe need examples:

Child 4: Information

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 4: School Information

Child 4: Shirt, Pant, Shoe Size and needs

Clothes/Shoe need examples:

Child 5: Information

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 5: School Information

Child 5: Shirt, Pant, Shoe Sizes and needs

Clothing/Shoe need examples:

Child 6: Information

Date of Birth Verification

One document from the list below:

Birth Certificate, CAPS certificate, Peach State/Medicaid (must show DOB), Vaccine Record/Dr. Check-up, SSI, Screenshot of Student from Campus Parent Portal.

DO NOT provide a Social Security card; it is not proof of birthdate.

Child 6: Shirt, Pant, Shoe Sizes and needs

Clothing/Shoe need examples:

Parent requests and Agreement

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