APPLICATION FOR ASSISTANCE
To be considered for assistance you must: 1.) Complete this electronic application completely and honestly. Incomplete applications will be rejected. 2.) Decatur County Residents only (Rural or City).
3.) Children under the age of 2-1/2 should be listed as months, so gifts are age appropriate.
4.) Children ages 16 and over will receive clothing certificates only.
Form must be submitted electronically or returned to the Daily News office, 135 S. Franklin Street,
PO Box 106, Greensburg, IN 47240-0106, no later than 4 p.m. December 2, 2019.
Deliveries made morning of Monday, December 24, 2019.
LIST ONLY THE MEMBERS WHO ARE LIVING IN YOUR
HOUSEHOLD AT THIS TIME
All children must be in school if of school age. Please submit curriculum if enrolled in online school. If under 2-1/2 years old, please use months. Please attach a separate sheet if additional children/adults are in household.
I certify the information below to be true to the best of my knowledge. I, the undersigned do hereby authorize the Daily News Cheer Fund Screening Committee to contact the following persons or agencies to determine if any kind of charitable assistance or gift will be given to me or my family during the current Christmas season. Subsequently I/We authorize the release of any information requested to the Daily News Cheer Fund. Example: Financial Institutions, Schools, Attorney, Employer(s), Landlord, Government Agency, Community Service Agency, and Relative, Friend, Neighbor or Others. I understand that all personal information requested to determine the charitable assistance or gift will be treated as confidential.
Please complete information below if submitted by individual not living at address above. In requesting assistance, I have verified all information is correct with the family and they are aware I have submitted this application on their behalf.