Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Must be in Benzie County or have children attending Benzie Central Schools.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Show of Need *

We are so grateful to the Benzie County Tool Box for the funds to extend this opportunity and make our programs more accessible! Please help us ensure we are being responsible with the allocation of these funds by explaining your financial need.

Kids qualify for free and reduced lunch at school

Our family qualifies for WIC benefits

Our family qualifies for Medicaid benefits

Loss of job

Single parent household

Unexpected financial strain

Grandparents raising grandchild(ren)

Parent or guardian is serving in the military

Other (please write below)

Checkbox

We provide free membership for active volunteers. Are you available to be an active volunteer?

Yes

No

I would like to discuss this with you