BACK TO SCHOOL SUPPLIES – RECIPIENT

Back To School Supplies Program - Recipient Application 2022

2022 Back To School Supplies Recipient Form

2022 Back To School Application for recipients

Back to School Supplies Program is for children attending grades K-12 for the 2022-2023 school year.

Registration starts May 4, 2022 and ends June 30, 2022.

You must be a Palatine Township resident and eligible for our programs. All communication will be by email. If you are new to the program you will be required to turn in documents via email.

If accepted,You will receive a letter with further instructions by Friday, July 15, 2022 with information required for the program.

If you do not receive your letter from the Township by July 21, 2022, please call the Township at 847-358-6700 for information.
Backpacks and school supplies will be distributed at Palatine Township on
- Thursday, July 28, 9:00 AM - 4:00 PM
- Friday, July 29 9:00 AM - 4:00 PM
- Saturday, July 30 9:00 AM - 12:00 PM
Date Submitted
General Assistance Case Number
If you participate in Township Programs, please provide your Case Number, found on your Food Pantry card or correspondence.
Parent/Guardian #1*
First Last
Parent/Guardian #2
First Last
Mailing Address*
Address City State ZIP Code
Phone*
Email*
Enter Email Confirm Email
Child's name*
First Last
Child's first and last name
School your child will be attending next year (2022-2023)*
Please only check on the school your child will attend starting September 2022.
Grade your child will be in next school year (2022-2023)*
Please select the grade your child will be in starting September 2022.
1st choice - PICK ONLY ONE*
You must choose a time for this date.
2nd choice - PICK ONLY ONE*
You must choose a time for this date.
3rd choice - PICK ONLY ONE*
You must choose a time for this date.
I am aware that participating in other organizations’ School Supply Programs is strictly prohibited. Agencies will cross reference lists, and if I am enrolled in more than one program I will be removed from the Palatine Township Programs for one year. I hereby authorize Palatine Township to use my photo in Township materials including newsletter, website and to release my name to volunteers/churches, and other organizations. I understand that my name will not be released to soliciting organizations. By clicking this checkbox, it serves as my signature and indicates that I agree with the terms of this program.
Agreement*
- I agree
I agree with Statement of Agreement above.
Email
This field is for validation purposes and should be left unchanged.