Please note:
the
pe r fe ct application for
h ol id ay assistance
gift
Applicant and Case Manager information will be kept confidential.
• Only Thornton residents within Thornton city limits, referred by participating
Case Managers, are eligible to participate. Applications must be sent from
the Case manager.
• The deadline to apply is November 18. Late applications will not be
considered.
• Applicants and their Case Managers can view the status of the application
at any time by visiting cityofthornton.net/CommunityConnections and
clicking on the “check application status” link. Please use this self-serve
system rather than calling us to check the status as this only creates delays.
• Only the applicant or the Case Manager can pick up the gifts. All matched
applicants are required to show a driver’s license or other state-issued photo
ID and a current utility bill to pick up gifts. Case Managers must bring an
agency ID.
Last Name of Family:
First Name of Adult(s):
Phone of Applicant or Case Manager:
Address of the Applicant:
Alternate Phone (optional):
City:
State: CO
ZIP:
Full Name of Referring Case Manager:
Name of Referring Case Manager’s Agency: City of Thornton
Applicant Email Address:
Case Manager Email Address:
Alternate Email Address (optional):
Assistance Requested:
■ Christmas/Holiday Dinner
How Many Adults are in the Home? 1
■ Christmas/Holiday Presents
How Many Children are in the Home?
2
Why do you believe your client should receive the perfect holiday gift? Donors will read when deciding who to adopt so please be detailed. (250 Word Limit)
Great Grandmother doing her best to raise two Great Grandsons. She and her husband cared for the boys 8 years and officially adopted them in 2012.
Her husband passed away a year ago and she needs assistance to provide presents for them this Christmas.
h o li d ay gif t wish list
p e r fect Please fill out the chart for ALL family members requesting presents. Specify Mens, Womens, Juniors, Boys or Girls sizes.
First Name
(You may use pseudo
names or numbers if
preferred)
Age
(Required)
Sex
M/F
EJ
10
M
Aden
8
M
Sharron
73
F
Staff Signature:
Office Only- Please do not write in this box.
APPLICANT NUMBER- 507
Ideas of things NEEDED
(Required)
Ideas of things WANTED
(DO NOT list any thing more than $40 in value
or your application will NOT be considered)
If shoes and/or clothing are
listed, please provide the sizes
for each.
Pants, shirts, shoes
Gift card for Game Stop Xbox or Walmart
Size 14 Husky pants
14-16 Shirts
7.5 shoes
Pants, shirts, shoes
Anything pertaining to baseball, especially the
Rockies, Gift card for Game Stop Xbox or
Walmart
Size 8 slim pants
Size 8 shirts
Size 1.5 shoes
Sweatshirts w design
Gift card for family bookstore or Hobby Lobby,
family restaurant, Boulder dinner theater
Women's XL
Recipient Signature:
Use the EMAIL APP button to send.
When prompted, follow the directions for sending through a desktop or Internet email provider.
Date:
EMAIL APP