Refer a Family

REFER A FAMILY

Working together, we can make a difference so single parent households in need have a Merry Christmas!
If you are a government or nonprofit social work agency, official caseworkers, or school counselors and know of a single parent family in need, please fill out the referral form below. When you refer a family, you help us verify vital information to ensure the family qualifies for the program.

For a family to be eligible, they must be:

Single mom with children under the age of 18 living in their home at least 50% of the time.
There should not be any significant other living in the home
Must have a financial need due to lack of employment or low wages or a recent set back that will make Christmas difficult this year
Preferably a recent home visit has been done but not required prior to referral.

Agency Referral

* Indicates required field

Agency/Company Name *

Agency Representative *

First

Last

Agency Main Phone *

Direct Phone *

Agency Email - *

Has a Recent Home Visit Been Performed *

Yes No

Name of Parent *

First

Last

Does the Parent Have Custody of Child(ren) *

Yes No

How Many Children 18 or Under Live in the Home *

Circumstance why your family is in need of Christmas assistance? *

Submit