All applicants must live in Phelan or Pinon Hills and be able to show income verification. Please complete the form below and someone will get back to you as quickly as possible.


Contact Information
Name
Phone Number
Fax Number
Email Address
Best time to contact you

Please Answer These Questions
Monthly Income
Please List Children, age, gender and gift preferences:
Do you need assistance with food?Yes
No
Have you contacted other Holiday Charities for Assistance? No
Grace Center
Tri-Community Toy Box
Salvation Army
Other