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Thisability Christmas Assistance Program

We're excited to offer holiday assistance to families with serve. To qualify, please ensure the following:

Eligibility Criteria:
Residence: Must live in Virginia, no more than one hour from Chester.
Age: Children up to age 18 with a disability are eligible. Siblings aged 13 and under will also qualify.
Financial Hardship: Must demonstrate financial need.
Application Process: To apply, please you MUST complete the application form below completely to be considered for assistance. Failure to due so may result in your application being denied.
Once we have completed reviewing your application you will receIve an email.

Apply here

First name*

Last name*

Email*

MUST COMPLETE IN FULL Address, City, Zipcode*

Phone*

How did you hear about us?*

My Preferred Language...*

NUMBER OF CHILDREN IN YOUR IMMEDIATE FAMILY YOU ARE APPLYING FOR? APPLYING FOR MORE THAN 5 CHILDREN YOU MUST COMPLETE AN ADDITIONAL APPLICATION FOR THE ADDITIONAL CHILDREN.*

CRITERIA ASSESSMENT CHECK ALL THAT APPLY to be considered for Assistance.*

I am having a FINANCIAL HARDSHIP.

SNAP /TANF/MEDICAID/ I have applied but I do not receive yet

Homeless /In the process of being evicted

Active or Military Veteran

Recently took custody of children

I have custody 51% or more during the year

I am the LegalGuardian / Parent of the children I am applying for.

I am a case manager/mental health professional applying for a client

I am applying only for those in my immediate family

I live no more than 1 Hour from Chester, Virginia 23831

I am able to provide Birth Certificates, Drivers License or ID

I HAVE AT LEAST ONE CHILD IN MY IMMEDIATE FAMILY THAT HAS A SPECIAL NEEDS or DISABILITY DIAGNOSIS between the ages of NB - 13 yrs. old

CHILD #1...FIRST & LAST NAME... LIST CHILD WITH SPECIAL NEEDS or DISABILITY DIAGNOSIS. *

What is the special needs diagnosis/disability? If no Special Needs or Disability please put relationship i.e. SIBLING*

GENDER*

BOY

GIRL

Birthday*

In order to get grants/funding please indicate the ethnic group this child identifies. For our bi-racial families please indicate both ie. black/white... This in no way affects your assistance. *

African American (Black)

Alaska Native/Eskimo

American Indian/Native American

Arab/Arab American

Asian

Caucasian/White

Hispanic/Latino

Pacific Islander

Undisclosed

NEEDS ASSESSMENT this will help us pick out the right toy for your child along with any restrictions due to sensory issues. Please do not skip this check all boxes that apply to your child.

High Functioning

Moderate Functioning

Low Functioning

Non-Verbal requires a device to communicate

Needs assistance with grooming, eating, dressing

Visual Impairment

Hearing impairment

Ambulatory Devices

No Loud Noise Toys

No Flashing Lights

NO restrictions

Wheelchair bound

Please list 3 Christmas wishes your child would like.

COAT, SHIRT, PANTS SIZES in the event we get clothing donations. *

Sponsored By:

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In Partnership with

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