Goodfellows 2019

  • 2019 Council Bluffs Goodfellows Application
  • Finish

To be considered, this fully completed and signed application must be submitted on or before Tuesday, December 3, 2019. Applications may be delivered to The Daily Nonpareil at 300 W Broadway, Suite 108, Council Bluffs, IA 51503. Applications that are not fully completed will not be accepted. Completing this application is not a guarantee of assistance.

Situation
Your Information
Family Member 1
Family Member 2
Family Member 3
Family Member 4
Family Member 5
Family Member 6
Family Member 7
Family Member 8
Family Member 9
Household Info

Note: Age, sex, race, ethnicity, veteran status and income are collected for statistical purposes only.

Current Address
Contact Person

In the event your address or phone number should change, please list a contact person and message phone:

Confirmation

By submitting below, I agree that the information provided is complete and accurate. I give my permission for all or part of my story – without my name or the names of my family members – to be published in The Daily Nonpareil.

Disclosure

Applications will be verified and de-duplicated with other assistance agencies. Only children age 16 and below are eligible for gift certificates. All household members are eligible for food certificates. Certificates will be mailed on or before December 12, 2019. (Age, sex, race, ethnicity, veteran status, household type and income is collected for statistical purposes only)

Verify and Submit

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