Do You Need a Helping Hand for the Holidays
2016 Holiday “Staff Helping Hands” Program Application
If you and your immediate family need assistance to brighten up the holidays this year we encourage you to apply below
(NOTE: Your personal information will be kept confidential but it is required)
NAME: ________________________________________ I AM A CURRENT UCI EMPLOYEE
DEPARTMENT: _______________________________________________
CONFIDENTIAL PHONE: ______________________________________
UCI EMAIL: ___________________________________________________
[CONFIDENTIAL FAMILY CODE: ___________________ (to be assigned)]
TYPE OF ASSISTANCE NEEDED:
CLOTHING
FOOD
GIFTS
GIFT CARDS
GAS
GROCERY
STORES
PREFERRED STORES
__________________
SCHOOL SUPPLIES
OTHER
I WOULD ACCEPT USED ITEMS IN EXCELLENT CONDITION:
YES
NO
Please describe your family & give a short explanation of why assistance is particularly needed this year:
________________________________________________________________________________________________________________
FAMILY MEMBERS: (Note: names will be replaced with codes prior to matching families with gifts
| | | | | | | | |
|CODE |NAME or Relation: |M / F |Age |Shirt Size |Pant / Skirt Size |Shoe Size |Preferences |
| |(son/ daughter/ spouse) | | | | | |(brief note) |
|_01 |Self: | | | | | | |
|_02 | | | | | | | |
|_03 | | | | | | | |
|_04 | | | | | | | |
|_05 | | | | | | | |
|_06 | | | | | | | |
|_07 | | | | | | | |
FAMILY WISH LIST – Please let us know if there are any specific wishes or needs this year:
Please be aware that, we may not be able to fulfill every wish or need that has been specified.
Depending on demand and interest, we may not be able to match all applicants with a sponsor.
You will be notified by email, November 16, 2016 whether your request has been matched. Please check your email in-box that day.
-----------------------
Please submit this form no later than NOVEMBER 3, 2016 via email or fax# to:
Andrea Wiley
Dev & Cell Biology –Zot 2300
wileya@uci.edu
949-824-4706
Fax 949-824-4344
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