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Family Assistance
Call in/paper application will open December 1st
Please fill out the form below
or download this
Assistance Application
Your Information
First Name
*
Last Name
*
Phone
*
Are you applying for your family or another family?
*
My Family
Another Family
The Family we can assist
Please note: The person referred must be a family friend or a family member not living with you.
Street Address
*
Apartment, suite, etc
City
*
Select
Eielson
Fairbanks
Nenana
North Pole
Salcha
Wainwright
Email
Phone
*
For the family you are referring
Special directions to locate the home
Is the family receiving services from other non-profits?
*
Salvation Army
Love INC
Project Christmas Hope
The Radio Station
Other
None
Please specify
*
Did this family receive assistance from Santa's Helpers last year?
*
Yes
No
Not sure
Do you need food boxes?
*
Yes
No
Please indicate ALL people living in the household listing ADULTS FIRST, including the applicant if you are referring your own family
How many people are living in the household?
*
Select
1
2
3
4
5
6
7
8
9
10
Including applicant
First Name
*
Last Name
*
Age
*
Select
Adult
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
First Name
*
Last Name
*
Age
*
Select
Adult
Newborn
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
*
Select
Female
Male
Family Title
*
Select
Mom
Dad
Grandparent
Son
Daughter
Other
Please Specify
*
Does the child(ren) have a bike(s)?
*
Yes
No
Unsure
What is the height of every child that needs a bike?
*
Do you currently have a child with special needs that is living in the household of the family you are applying for?
*
Yes
No
Unsure
Tell us your child's special needs for play
*
Reference
First Name
*
Last Name
*
Phone
*
Anything else you want to share?
Send Message
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