Toys for Tots
Application for Assistance Christmas 2018
You must complete all sections of the form and provide proof of the documentation necessary for approval AT THE TIME OF REGISTRATION. All information is confidential. Rules for acceptance and participation in this program are the same for everyone without regard to race, religion, color, national origin, age, sex or disability.
—Monthly Gross Income to Qualify—
|HOUSEHOLD SIZE||MONTHLY INCOME||HOUSEHOLD SIZE||MONTHLY INCOME|
Your Name__________________________________________________ Your Phone # ______________________________
Address_____________________________________________________ Your Email________________________________
Marital Status: S M* D SEP W *Spouse’s Name ____________________________ Total # in Household _________
YOU MUST PROVIDE PROOF THE FOLLOWING DOCUMENTS WITH THIS APPLICATION TO BE CONSIDERED—
q Your Photo ID
q Proof of residency in Plaquemine Parish
q Any ONE of these forms for each person in the household: SS Card, Birth Certificate, School ID or Medicaid/Insurance Card
q Mark any/all programs you are currently eligible for or enrolled in: ____ Free/Reduce School Meal ____WIC ____ Government Assistance program
ALL persons 17 YEARS AND OLDER of age living at this address with income—
|FIRST & LAST NAME (Include self)||RELATIONSHIP||AGE||INCOME|
Children 16 YEARS AND YOUNGER of age living at this address—
|FIRST & LAST NAME||GENDER||AGE||GRADE & school|
All information that I have provided is true and complete to the best of my knowledge. I understand that this program is not guaranteed. I am responsible for notifying Toys for Tots should my contact information change.
Your Signature____________________________________________ Date_________________________
RETURN YOUR COMPLETED APPLICATION AND ALL DOCUMENTATION TO:
Phone: (562) 257-8854 Email: Makaret385@yahoo.com
For Plaquemines Parish
Registration point of contact:
Mak Lim @ (562) 257-8854
Registration will be held at
YMCA Belle Chasse
Belle Chasse, LA 70037
Sunday November 4th from 1:00p.m. – 5:00p.m.
Sunday November 11th from 1:00p.m. – 5:00p.m.
Sunday November 18th from 1:00p.m. – 5:00p.m.
Distribution will be held at
CubeSmart Self Storage
9491 Hwy 23
Belle Chasse, LA
Sunday December 16th from 1:00p.m. – 5:00p.m.