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blue banner with hendricks co fop lodge 132 wording

School Supplies and Clothing Assistance Application


Application should be completed and returned to the above address.  Do not leave any spaces blank.  A telephone number must accompany this form.  Your child must attend a school in Hendricks County and be in Grade K – 8 to participate.  On the shopping day, your child will need to bring a copy of the school supply list with them.  (Use back of Form for Additional Children)


Child’s Name: _________________________________________  Age:  ___________ Grade:  ________


Child’s Name: _________________________________________  Age:  ___________ Grade:  ________


Child’s Name: _________________________________________  Age:  ___________ Grade:  ________


Name of Responsible Party: _______________________________________________________________


Relationship to Child: (Circle One)    Guardian      Parent


Address:  _____________________________________________ 




Telephone Number:____________________  Best time to call: __________________


Total Annual Household Income: (Check One)

______  $0 to $10,000.00

______  $10,000.00 to $15,000.00

______  $15,000.00 to $20,000.00

______  $20,000.00 to $25,000.00

______  $25,000.00 to $30,000.00

______  Over $30,000.00


Number of persons in household:  ____________


Have you recently been laid off?  (Circle One)  Yes    No


Name of School: ______________________________________  First Day of School:  _______________


Form should be completed and mailed to:                     Megen Morgan – Secretary

                                                                                                FOP Lodge 132

                                                                                                P.O. Box 132

                                                                                                Plainfield, IN  46168



Click here for printable Application
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