Back-to-School Assistance Application

PLEASE READ: Instructions for Completing the Form.

Please click on the blue 'add' button below to tell us what is needed. Click the 'add another' button until you have registered all of your children who need school supplies. After you have told us what your children need, then continue to complete the parent / adult section. At the end of this form you must click the blue 'register' button to send the form.
Questions? Please email pgme@projectgracemaine.org or call us at 883-5111. If you need to sign up more than 6 kids, please call or email us for instructions.

You may add a maximum of 6

* First Name:
* Last Name:
*
What is needed?
- School Supplies
- Backpack
- Backpack AND School Supplies
*
Child's School
- Scarborough High School (9-12)
- Middle School (6-8)
- Wentworth Intermediate School (3-5)
- Blue Point Elementary (K-2)
- 8 Corners Elementary (K-2)
- Pleasant Hill Elementary (K-2)
- Homeschool
- Other
*
Grade level
- Kindergarden
- 1st
- 2nd
- 3rd
- 4th
- 5th
- 6th
- 7th
- 8th
- 9th
- 10th
- 11th
- 12th
- other
Gender (optional)
- Boy / Male
- Girl / Female
- Non-binary / Neutral / Prefer not to say
What color backpack is preferred (no guarantees, but we'll do our best).
- Black or Gray
- Blue or Green or Teal
- Red or Orange
- Purple or Pink
- Special characters (superheros, unicorns, etc.)
Comment or Question

In this section, please give the ADULT's information. Enter info about your children in the STUDENT section above (click the add button to start).
* First Name:
* Last Name:
* Email Address:
* Confirm Email Address:
* Phone:
* Address 1:
* City:

This section is optional, but helps us apply for grants and community support and plan our programs. We appreciate your willingness to share your personal information and will keep your answers confidential.
How many people, adults and children, live in your household?
Is your family signed up for the weekly food 'backpacks' from school nutrition?
- Yes, we are signed up.
- No, we know about the program and are not signed up.
- No, we have not applied or need more info.
What is your household's usual monthly income?
Has your household lost or expect to lose income as a result of COVID-19?
Comment or Question

If you already have a Project GRACE code name, please enter it here. If you do not have or can't remember your code name, please leave blank.
CODE NAME