Backpack Application

Backpack & School Supplies Application

ELIGIBILITY: Must live in Halton Hills (Acton or Georgetown). Maximum after tax income of total number of people living in the home: 2 people – $55,000; 3 people – $60,000; 4 people – $65,000; 5 people and over – $70,000 + $2,500 for each additional person

Company

This field is for validation purposes and should be left unchanged.

CONTACT Name(Required)

First Last

ADDRESS (must live in the Town of Halton Hills: Acton or Georgetown)(Required)

Street Address Address Line 2 City Province Postal Code

Phone

CHILDREN'S INFORMATION(Required)

First Name

Last Name

Gender

Grade

Date of Birth (dd/mm/yyyy)

HOUSEHOLD INCOME (monthly, after-tax $ amounts)(Required)

ODSP

E.I.

O.W.

CPP Disability

Support Payments

Employment

Other (amount)

Other (details)

Total

CONSENT TO DISCLOSE INFORMATION(Required)

Personal information is collected solely for determining program eligibility to ensure support for those most in need. Information is kept strictly confidential. Contact Links2Care’s Privacy Officer at 905-873-6502 or [email protected] for more details.

I authorize Links2Care to release/request information and advocate on my behalf and release Links2Care from all claims and liabilities arising out of the release/request of this information.

Date(Required)

UPLOAD MOST RECENT NOTICE OF ASSESSMENT

Drop files here or

Max. file size: 20 MB, Max. files: 10.

We will contact you in late August or early September with pick-up details.

Backpack & School Supplies Application

Contact us to learn more