Apply Here for the Cape Ann Kids Holiday Fund 2024

HOW TO APPLY

Applications must be received by December 1, 2024.
Unfortunately, we will not be able to accept applications after that date.

IMPORTANT INFORMATION – Please Read Carefully!

· Make sure to fill out the entire form and
provide the correct contact information.

· To be eligible, you must currently live in
Gloucester, Rockport, Manchester, Essex, or Ipswich.

· Children must be 0-18 years of age, with December
31, 2006 as the cutoff birth date.

· You may only apply ONCE per child (if a child
shares time between multiple households, only one household/parent may apply). If
more than one person applies for a child, all applicants will be notified and
the applicants will determine who will pick up gifts for the child.

· After you submit your application, you will be
notified by email that we have received your application. If you do not
receive a confirmation email, your application did not go through. Please
call us at 978-479-4088. for assistance.

· After your application has been successfully
submitted, we will contact you via email between Dec. 6 – Dec. 13 to schedule
an appointment for the holiday store. We will only contact you before Dec. 6 if
you are NOT eligible for the fund.

· Children ages 9 and under will receive toys. Children
ages 10 – 18 will receive a gift card.

Apply Here for the Cape Ann Kids Holiday Fund 2024

Do you live in Gloucester, Rockport, Ipswich, Essex, or Manchester-by-the-Sea?*
- Yes, Gloucester
- Yes, Rockport
- Yes, Ipswich
- Yes, Essex
- Yes, Manchester-by-the-Sea
- No, I do not live on Cape Ann
First Name of Parent/Guardian #1*
Last Name of Parent/Guardian #1*
Full Name of Parent/Guardian #2 (If Applicable)
Parent/Guardian Contact Information*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number*
Email*

This field is required to apply. If you do not have an email address, please call 978-479-4088.
Parent/Guardian Date of Birth*
Month
Day
Year
Parent/Guardian Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Primary Language of Parent/Guardian*
- English
- Portuguese
- Spanish
- Kreyòl Ayisyen
- اَلْعَرَبِيَّةُ
Which of These Agencies Are You Currently Working With?*
- Action Inc.
- Pathways For Children
- Wellspring House
- I Have Not Used Any of These Agencies Before
**If you have not used any of these agencies before you are still able to submit an application**
How many CHILDREN ages 0-18 are in your household?*
- One
- Two
- Three
- Four
- Five
- Six
- Seven
- Eight
- Nine
Child #1: First Name*
Child #1: Last Name*
Child #1: Date of Birth*
Month
Day
Year
Child #1: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #2: First Name*
Child #2: Last Name*
Child #2: Date of Birth*
Month
Day
Year
Child #2: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #3: First Name*
Child #3: Last Name*
Child #3: Date of Birth*
Month
Day
Year
Child #3: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #4: First Name*
Child #4: Last Name*
Child #4: Date of Birth*
Month
Day
Year
Child #4: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #5: First Name*
Child #5: Last Name*
Child #5: Date of Birth*
Month
Day
Year
Child #5: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #6: First Name*
Child #6: Last Name*
Child #6: Date of Birth*
Month
Day
Year
Child #6: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #7: First Name*
Child #7: Last Name*
Child #7: Date of Birth*
Month
Day
Year
Child #7: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #8: First Name*
Child #8: Last Name*
Child #8: Date of Birth*
Month
Day
Year
Child #8: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Child #9: First Name*
Child #9: Last Name*
Child #9: Date of Birth*
Month
Day
Year
Child #9: Gender*
- Male
- Female
- Nonbinary
- Transgender
- Questioning
- Other
Where does your household receive income from?*
- Employment
- Unemployment
- Child Support
- Alimony
- TANF/TAFDC
- SSI
- SSDI
- Other
- No Income
Does your household receive benefits? (SNAP, WIC, Section 8, Fuel Assistance, etc.)*
- Yes
- No
What benefits does your household receive?
- Affordable Care Act Subsidy
- Chapter 115 Veterans’ Benefits
- Childcare Voucher
- EAEDC
- Fuel Assistance
- HomeBASE
- HUD-VASH
- Public Housing (NOT Section 8)
- Section 8/Housing Choice Voucher
- SNAP
- SSDI
- SSI
- State Supplement
- TAFDC
- WIC
- Other Permanent Supportive Housing
- Other
What is your current housing status?*
- Own
- Rent Without Subsidy
- Public Housing
- Section 8/Subsidized
- Homeless
- Other
What is your family/household type?*
- Single Parent
- Two-Parent Household
- Non-Related Adults with Children
- Multi-Generational Household
- Other
Consent Form*
I understand that Action Inc., Wellspring, and Pathways for Children are social services organizations with a mission to help families. I also understand that by submitting this application, I authorize Action Inc., Wellspring, and Pathways for Children staff to share information about me and my family with other Action Inc., Wellspring, and Pathways for Children staff for the purposes of coordinating services and making referrals. I understand that the three agencies will keep my personal information confidential except as required by their funding sources or as required by law. Under all other circumstances, the agencies will only share my information with my written consent. I understand that I am not required to share this information and that this authorization will not affect my eligibility for additional services. I understand that I may withdraw this consent at any time, in writing, by contacting strupiano@actioninc.org. *PLEASE NOTE: Accepting these terms is required to participate in the program.
- I accept.
Based on your responses, it appears that you are not eligible for this program. If you believe you should qualify for assistance through this program, please contact 978-479-4088..