2022 Goodfellows application – Goodfellows of Kokomo

2022 Goodfellows application

Thank you for your interest in applying for this year's Goodfellows of Kokomo program! You can watch this video on how to apply. Before you get started, remember that you must have the following items available when you register: 1. Current Howard County picture ID or driver’s license for every adult in the household 2. Birth certificates for every child in the household and student ID for everyone ages 16-18 in household 3. Verification of all income, including net wages for everyone living in the household for the last 30 days 4. Receipts for all bills paid in the last 30 days 5. Any paperwork proving guardianship of children Eligibility guidelines are as follows: --Children ages newborn – 15 years --Children ages 16-18 years with verifications of school registration --Everyone must have residence in Howard County, Indiana NO children are permitted during shopping dates at Kohl's or during the Toys for Tots dates, but children are expected for the Cops4Kidz Partnered with Goodfellows breakfast and shopping day. When completing your Goodfellows registration, you will also be able to sign up for the Kokomo FOP #078 Cops4Kidz Partnered with Goodfellows program if you wish to do that program. Both programs participate in the Marine Corps Toys for Tots program. If you opt to be adopted, you will need to complete some additional specific information for the business, organization, group, or family who is adopting your family, and you will not be able to participate in the other programs listed above. Remember to opt in on our website to receive messages and to receive application status updates, voucher details, and reminders!

About you - Step 1 of 8

Your name *

First

Middle

Last

Provide the name of the person completing the application.

Do you live in Howard County, Indiana? *

Unfortunately, we only serve residents in Howard County, Indiana. Contact 211 for more information about holiday assistance programs in your area.

Your phone number *

I understand that by providing my phone number, I may receive calls or text messages with updates on my application, vouchers, reminders, and more. I also understand that if I change my phone number after submission that I need to submit a change form here.

A secondary phone number *

A secondary phone number is required. We will ONLY use this number if we cannot reach the first phone number listed.

Your email *

GDPR Agreement *

I consent to having my email saved to receive updates on my application, vouchers, reminders, and more.

I understand that I have to provide an accurate email address to receive this information and it is my responsibility to make sure my information is not only correct, but also remains checked periodically for important updates about my application and program information.

Your driver's license or ID number *

Make sure this is current and valid. It must show a HOWARD COUNTY, INDIANA residence. No out of state ID's are accepted.

Upload your driver's license or ID here *

Click or drag a file to this area to upload.

You must provide a current driver's license or ID that matches your listed address in order to qualify.

Your date of birth *

Age *

Marital status *

Your address *

Address Line 1

Address Line 2

City

State

Zip Code

Where are you currently employed? *

You must provide a response. If you are not employed, enter NOT EMPLOYED.

What is your occupation?

How many adults (including yourself) live in your household?

Selected Value: 1

How many children ages newborn to 15 live in your household?

Selected Value: 0

How many children ages 16-18 live in your household?

Selected Value: 0

Please provide details for all of the other adults (over 18) in your household.

This does not include you, the applicant.

Name *

First

Middle

Last

Relationship to you *

Driver's license or ID number *

Upload the driver's license or ID for the person listed *

Click or drag a file to this area to upload.

Date of birth *

Age *

Name *

First

Middle

Last

Relationship to you *

Driver's license or ID number *

Upload the driver's license or ID for the person listed *

Click or drag a file to this area to upload.

Date of birth *

Age *

Name *

First

Middle

Last

Relationship to you *

Driver's license or ID number *

Upload the driver's license or ID for the person listed *

Click or drag a file to this area to upload.

Date of birth *

Age *

Name *

First

Middle

Last

Relationship to you *

Driver's license or ID number *

Upload the driver's license or ID for the person listed *

Click or drag a file to this area to upload.

Date of birth *

Age *

Name *

First

Middle

Last

Relationship to you *

Driver's license or ID number *

Upload the driver's license or ID for the person listed *

Click or drag a file to this area to upload.

Date of birth *

Age *

How many other other adults are living in your household? *

Please provide details for all of the children in your household who are ages newborn to 15.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relationship to you *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Child's age *

Upload birth certificate *

Click or drag a file to this area to upload.

Please provide details for all of the children in your household who are ages 16-18.

Please list everyone ages 16-18 in the household even if they are not in school.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Child's name *

First

Middle

Last

Relation to you? *

Child's gender *

It is important to identify your child's gender to be sure we can equitably divide resources.

Date of birth *

Age *

Upload birth certificate *

Click or drag a file to this area to upload.

What school does this child attend?

Upload school ID for this child *

Click or drag a file to this area to upload.

Which of the following do you and members of your household receive or have received within the past 30 days? *

HUD/Section 8/housing assistance
Trustee assistance
TANF
SS/SSI/SSDI
Child support
Wages
Friends/family
Other

Select all that apply

What value was the housing assistance you received in the past 30 days? *

How much did you receive in trustee assistance in the past 30 days? *

How much TANF assistance did you receive in the past 30 days? *

How much social security income did you receive in the past 30 days? *

How much child support did you receive in the past 30 days? *

What is the net (after taxes) amount of wages you received in the past 30 days? *

How much financial support did you receive from friends and family in the past 30 days? *

If you have received funds from friends or family, you must upload a signed document with a valid phone number and name of contact.

What other funds have you received in the past 30 days? *

You must upload proof of all funds received.

Upload ALL income documents here. *

Click or drag files to this area to upload. You can upload up to 100 files.

Which of the following bills have you PAID within the past 30 days? *

Rent
Electric
Gas
Water
Sewage
Cable/streaming
Internet
Vehicle payment
Home/auto insurance
Credit card(s)
Phone/cell
Food
Taxes
Daycare
Health insurance
Non-food items
Gasoline
Other

Select all that apply and have been PAID in the past 30 days.

How much rent did you pay in the past 30 days? *

How much did you pay on your electric bill in the past 30 days? *

How much did you pay on your gas bill in the past 30 days? *

How much did you pay on your water bill in the past 30 days? *

How much did you pay on your sewage bill in the past 30 days? *

How much did you pay on your cable bill or subscription services in the past 30 days? *

Include subscription services like Netflix and Hulu.

How much did you pay on your internet bill in the past 30 days? *

How much did you pay on your vehicle in the past 30 days? *

How much did you pay on your home and/or auto insurance in the past 30 days? *

How much did you pay on your credit card(s) in the past 30 days? *

How much did you pay on your phone and/or cell phone in the past 30 days? *

How much did you pay for food in the past 30 days? *

Do not include food purchased with food stamps.

How much did you pay in taxes in the past 30 days? *

How much did you pay in daycare in the past 30 days? *

How much did you pay in health insurance in the past 30 days? *

How much did you pay in non-food items over the past 30 days? *

Include toiletries and personal items here.

How much did you pay in gasoline in the past 30 days? *

What other expenses did you pay out in the past 30 days? *

Only include what you have paid.

How much did you pay in other expenses? *

Upload all bills and evidence of payments made in the past 30 days here. *

Click or drag files to this area to upload. You can upload up to 100 files.

If you do not include a receipt of payment, that bill will not be included in your expenses.

Which program(s) would you like to participate in? *

Goodfellows of Kokomo & Toys for Tots
Cops4Kidz Partnered with Goodfellows of Kokomo & Toys for Tots
Family adoption
Whichever program Goodfellows think is best for our family.

Remember, if you are adopted out by a family or organization, you cannot participate in the other programs and you will need to fill out other information that we will provide to you. If you are unsure of the different programs, PLEASE go to the website and check out the section about the each of the different programs.

I affirm that the information supplied by me on this application represents the true facts of my household fully and completely as I know them. I also understand that any attempt to misrepresent the facts or to give false or misleading information shall result in my disqualification for any assistance from Goodfellows of Kokomo, Cops4Kidz Partnered with Goodfellows of Kokomo and/or Toys for Tots. I also understand that my photo and/or the photo of those in my household may be taken and used on all media outlets. *

Please use your finger to sign if you have a touchscreen or your cursor to sign if you do not have a touchscreen.

Goodfellows admin

DO NOT COMPLETE THIS SECTION. THIS IS FOR ADMIN PURPOSES ONLY!

Total adults (18+)

Total children

Total income

Total expenses

Number of females age 0

Number of females age 1

Number of females age 2

Number of females age 3

Number of females age 4

Number of females age 5

Number of females age 6

Number of females age 7

Number of females age 8

Number of females age 9

Number of females age 10

Number of females age 11

Number of females age 12

Number of females age 13

Number of females age 14

Number of females age 15

Number of females age 16

Number of females age 17

Number of females age 18

Number of males age 0

Number of males age 1

Number of males age 2

Number of males age 3

Number of males age 4

Number of males age 5

Number of males age 6

Number of males age 7

Number of males age 8

Number of males age 9

Number of males age 10

Number of males age 11

Number of males age 12

Number of males age 13

Number of males age 14

Number of males age 15

Number of males age 16

Number of males age 17

Number of males age 18

Application Worked on by:

Status

More information is needed
Denied
Approved

Email Notification

Date which email was sent to notify recipient of status.

Program approved for

Goodfellows shopping & Toys for Tots
Cops4Kidz Partnered with Goodfellows of Kokomo & Toys for Tots
Adoption

Voucher Amount

Shopping Date / Time

Date

Time

Additional Notes