USD 323
Christmas Bureau 2008
1. Applications will be received from November 12 through December 10, 2008
2. Applications for assistance will be accepted only from USD 323.
3. Assistance is NOT guaranteed and adoption will NOT provide a “total Christmas” for a family. Your help in communication of this information is both appreciated and beneficial in that it will reduce disappointment if need cannot be met.
4. Typically, there is to be only one application per household. Each case, however, will be evaluated on an individual basis, if necessary.
5. Each family must personally complete and sign the Christmas Bureau application form.
6. If the applicant does not have a phone, please indicate a contact phone number.
7. The applicant needs to indicate the best time of day to be contacted.
8. Specific information can be included about special needs which could assist the adopting family. Specific clothing sizes can be included. Be as accurate as possible.
9. Indicate any language barrier on the form.
10. All forms should be kept on file by the agency.
11. When an adoption occurs:
a. A confirmation letter is sent to the family. The adopting family’s name is included in the letter.
b. A letter with a copy of the applicant’s completed application is sent to the adopting family. The donor family is to immediately contact their recipient family.
c. Records of the adoption will be kept confidentially by the Christmas Bureau.
If you have any additional questions or concerns, call Community Health Ministry, 456-7872, ask for Andrea Monday- Friday 10-4:30.
USD 323
Christmas Bureau 2008
Bring to CHM, 903 6th St., Wamego, Ks. 66547 or call 456-7872 ask for Andrea
To be completed by individuals, families, and groups adopting a family
Individual/family______
Organization name (if adopting) ______
Contact person ______
Address ______
______
Phone number______
Size of family you wish to adopt ______
Christmas Bureau use only
Family adopted______
Address ______
______
Phone ______
Date notification letter sent ______
USD 323
Christmas Bureau 2008
You will receive a letter when your application is matched with a family
Name ______
Last First
Address ______
Best time and day to contact you ______
Telephone ______Please check one: __Your phone __Friend or relatives phone__(it is your responsibility to inform peole you are using their number for contact)
Directions to your home if it is difficult to locate ______
______
Assistance needs (check all that apply) ____Blankets ____Clothing ____ Food ____ Toiletries ___Toys
Members of the household
Name Age Gender clothing size(optional)
______
______
______
______
______
( Any information: special needs or circumstances, illnesses, allergies, English as a second language: optional )
Additional information: special needs or circumstances, illnesses, allergies, English as a second language: optional.
______
______
Call CHM 456-7872, 903 6th St. ask for Andrea
Permission: I certify that I live within the USD 323 school district. I grant permission to share information contained on this form and any necessary verification to the CHM Christmas Bureau program.
______Date: ______
Applicant’s signature
Bureau use only
Adopted by ______
Address ______
Phone ______Date notified: ______