Hope United | Ada Regional United Way

Hope United

Did you and/or your family members receive assistance from Hope United in 2024?

Yes

Are you or your children a CDIB holder with the Chickasw Nation?

Yes

I understand that completing this application does not guarantee the receipt of any gifts, the quality or quantity of gifts as they are dependent upon the donation from others. I hereby give permission to release this information to another party (group or individual)for assistance in verifying my eligibility.

Head of Household

Head of Household First Name

Head of Household Last Name

Gender

Race

Street Address

City

State

Postal Code

Phone

Email Address

Total Number of People that Live in Your Home

Household Member #1

Household Member 1 First Name

Household Member 1 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

Household Member #2

Household Member 2 First Name

Household Member 2 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

Household Member #3

Household Member 3 First Name

Household Member 3 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

Household Member #4

Household Member 4 First Name

Household Member 4 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

Household Member #5

Household Member 5 First Name

Household Member 5 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

Household Member #6

Household Member 6 First Name

Household Member 6 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

Household Member #7

Household Member 7 First Name

Household Member 7 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

Household Member #8

Household Member 8 First Name

Household Member 8 Last Name

Gender

Race

Date of Birth

Age

Gift Choice 1

Gift Choice 2

Gift Choice 3

Clothing Type

Pant Preference

Toddler Coat Size

Toddler Shirt Size

Toddler Pant Size

Child Coat Size

Child Shirt Size

Child Pant Size

Infant Coat Size

Infant Shirt Size

Infant Pant Size

Womens Coat Size

Womens Shirt Size

Womens Pant Size

Juniors Coat Size

Juniors Shirt Size

Junior Pant Size

Mens Coat Size

Mens Shirt Size

Mens Pant Size

Shoe Type

Infant Shoe Size

Toddler Shoe Size

Little Kid

Bid Kid

Women's Shoe Size

Men's Shoe Size

File Uploads

Upload income verification for all family members residing in the home (paystubs, tax doc, child support, current TANF, SNAP or WIC award letter, SSI/SSDI etc)

Upload requirements

Upload proof of residency with current address (utility bill, rental agreement, etc).

Upload requirements

By signing you are acknowledging that the information provided is true and correct to the best of your knowledge.

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