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Family Christmas Sponsorship Application -
Deadline is December 10th
Name of Individual Making the Referral:
Contact Phone Number:
(xxx-xxx-xxxx)
Contact Email Address:
Name of Family being referred:
Name:
Age:
Gender:
1.
Female
Male
2.
Female
Male
3.
Female
Male
4.
Female
Male
5.
Female
Male
6.
Female
Male
7.
Female
Male
8.
Female
Male
9.
Female
Male
10.
Female
Male
Reason/Hardship Circumstance:
(Please give detailed information as to why NWA should sponsor this particular family. Use additional paper or back side of this application if necessary)
Wish List:
(Please note that there is a $500 limit on each family, so if a Christmas meal is requested that should be factored into the wish list. Please specify what item is for which member by numerical value above in the description of the family. If clothing/shoes are requested please include the size/s. Use additional paper or back side of this application).
Northwest Alternatives, Inc © 2010
