2023 Operation Holiday Application – HumanKind Ministries

Unique ID

Submission Number

Are you a case manager filling this out for a client?*

Yes
No

Please select your location/organization from the dropdown menu below:*

Are you picking up items on your client's behalf?*

Yes
No

Are you filling this out at an application site?*

Yes
No

Please select your the application site from the dropdown menu below:*

Enter the application site:*

If you chose OTHER, please enter what site you are filling your application out at (Name and Address)

Please select ALL that you are requesting

Vouchers
Food
Pet food
Children's coats
Toys

Pickup Date and Time:*

Operation Holiday will take place in a WALK-THROUGH format. Please plan for 30 minutes to park, come in and collect the items assigned to you, and take items back to your vehicle. If you arrive PRIOR TO your selected pick up time, you will be asked to come back for your correct time and date. No acceptions.

Name*

First Last

Email*

Last 4 Digits of SSN:*

Date of Birth:*

Gender:*

Address:*

Street Address Address Line 2 City State ZIP Code

Please abbreviate directions. No punctuation after.
Ex: North = N, South = S, etc.

Street names must be listed as abbreviations. No punctuation after.
Ex: Street = St, Road = Rd, Circle = Cir, Lane = Ln, Avenue = Ave, Court = Ct

Telephone/Message Number:*

Marital Status:

As stated on your taxes

Language Preference:

Race:

Do you have pets?

No
Yes

Dogs and/or Cats?*

Dogs
Cats

Please select all that apply

Spouse/Other Adults Living in the Household

Age 18 or older. You will NOT be able to edit this section after application submission, please include ALL adults in the household.

Adults in household

Name	Last 4 Digits of SSN:	Date of Birth:	Gender:	Actions

There are no Adults.

Only one application per household. Please add additional adults living in the same household in the “add adult” section above.

Children Living in the Household

Age 17 or younger. You will NOT be able to edit this section after application submission, please include ALL chidlren in the household.

Children in household

Name	Age	Gender:	Coat Size:	Coat Priority	Actions

There are no Children.

Income

Please enter your household's 2-month gross income; including any disability, social security, child support, etc.

2-month household income exceeds income eligibility.

2-Month Family Income:*

Income Source:*

Employer:

Proof of Income

Accepted file types: jpg, gif, png, pdf, Max. file size: 300 MB.

If you cannot upload proof of income at this time you will need to bring proof of income to distribution.

Disclaimer*

I agree.

I certify that the information I have provided is true and correct. I am aware that failure to provide complete information or the completion of more than one application may be grounds for denial of assistance. I consent to the release of pertinent information contained on this form as necessary to concerned social services agencies, HumanKind Ministries, Salvation Army and vendors. I agree that HumanKind Ministries may use photographs of me with or without my name.

I understand that participation in the Operation Holiday distribution process involves a certain degree of risk. I have carefully considered the risk involved and hereby consent to participate and fully understand the risk associated with my participation. I understand that participation is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I knowingly and voluntarily release HumanKind Ministries, Inc., Wichita, the activity coordinators, officers and directors, all employees, volunteers, related parties, clients, or other organizations associated with the activity from any and all claims or liability arising out of this participation.

I understand.

I understand that I must bring proof of income with me to distribution. I understand that by NOT doing so, I may not receive assistance.

Household total*

Is the primary contact for this application different than the contact information provided above?*

Yes
No

*Case Managers and Application Sites, please keep as 'No'*

Contact Information of Person Filling Out Application*

If you are filling out this form for someone else, please let us know how we can contact you in case we have any questions

CAPTCHA

Please ensure all information above is accurate/complete to your knowledge. Once your application has been submitted, you CANNOT go back and add/alter information - to add/alter information, you will have to call HumanKind and complete a new application

Operation Holiday Application 2023

Spouse/Other Adults Living in the Household

Children Living in the Household

Income

HumanKind Ministries