Porta Community Unit School District #202

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Menard County Back to School Supply Application

MENARD COUNTY

BACK TO SCHOOL

SCHOOL SUPPLY APPLICATION

 

Dear Applicant:

 

The 2021 - 2022 school year will be here before we know it so it’s time to start planning for the purchase of your family’s school supplies.  Organizations and individuals provide funding and supplies to assist Menard County residents, especially the children, with only basic supplies for each county school district.  The below application is to gather information regarding school enrollment, age, gender and grade level for the upcoming school year.

 

If you are interested in having your family referred for school supplies, please sign your name, complete the bottom of this page, and return it to the below listed office no later than Friday, July 16, 2021

 

PLEASE PRINT IN BLACK INK

 

PARENT NAME:  ___________________ ADDRESS:  _____________________________________________

 CITY:  _______________________________________

PHONE OR TEXT NUMBER FOR PICKUP INFORMATION: ______________________________________

 

 

_______________________________________________________________

Signature                                                                                               Date

 

PLEASE LIST ONLY THOSE CHILDREN RESIDING WITHIN YOUR HOUSEHOLD AND ENROLLED IN A LOCAL SCHOOL.  PLACE AN “X” IN EACH GRADE LEVEL FOR EACH CHILD.

NAME

GENDER

DISTRICT

EC

K

1

2

3

4

5

6

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ONLY BASIC SUPPLIES WILL BE PROVIDED.  BOOK BAGS ARE NOT GUARANTEED.

 

PLEASE RETURN COMPLETED APPLICATION TO:

 

CENTRAL IL SERVICES

P.O. BOX 168, 101 WEST SHERIDAN

PETERSBURG, ILLINOIS  62675