New Family Application

Head of Household Information

First name

Last name

Email address

Phone Number

Date of Birth

Last 4 of Your SSN

Gender

Eligibility Requirements

Must live in the Bradford School District to be eligible for this program. Bradford School District Map

Street Address

City

State / Province

ZIP / Postal

Any major life events or impacts in the last year?

Income Verfication

A copy of a Paystub, SSI, Compass or other similar document are valid forms of income verfication. Please provide documents for all members living in the home. At least one income verification document is required.

Income Amount

Source

Verification Document (image or pdf) *

Family Members in the Home

Children

First Name

Last 4 of SSN

Age

Gender

Toy Requests

Clothing Requests

Shirt Size

Pant Size

Shoe Size

Additional adults living at this address:

First Name

Last 4 of SSN

Age

Gender

Other

Would you be willing to be contacted by the Bradford Era for a story (not using your real name)?

By signing this you agree to the terms and conditions, the information that you have provided is accurate and true, and also authorize the Era's Less Fortunate Fund to verify all information in this application.