Other Basic Needs

Bedding, toiletries, bassinets, diapers, pajamas, shoes & socks.

*This program does not include clothing.

Shelter/Safe House

If you currently live in a shelter or safe house, please list the name and contact info for the shelter/safe house.

Additional Information

Adult #1

Adult #2

Adult #3

Adult #4

Child #1

Child #2

Child #3

Child #4

Child #5

Child #6

Demographic Information (optional)

This information is used for funding purposes only! Your answers will not impact the fulling of your order in any way (even if you choose not to complete it). The information gathered may help Project Just Because to receive grants to further benefit those in need. Thank you!
(Please select all that apply)
If you selected "other", please describe how you identify your ethnicity.

Submit

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