The Elf Project for A Child's Christmas
PO Box 151
Lenoir City, TN 37771
Please print this page, give to your reference person, and send to the address above.
Reference must be professional who can verify your situation. Deadline is November 15.
Please print clearly.
Dependable phone numbers where we can reach you: __________________ _______________________
Married____ Separated____ Divorced ____ Single____
Social Security #: ________________________________
Current employment: ______________________________
Monthly Household Income: $____________
Check if you or your children receive:
_____Food Stamps (SNAP) _____WIC _____TennCare/Kids _____Disability SSI _____Child Support:
Total Amount per month $_______
Please give the names and ages of your children 12 and under:
___________________________________ _____ (use the back if needed)
On reverse please add any circumstance that will help us assess your need. All information will remain confidential.
This section to be completed by agency representative who will verify your need (Family Promise, Head Start, Church pastor, Helen Ross McNabb, etc.)
Phone Number: ___________________Ext____________
Remember Deadline is November 15