Application to receive school supplies

Child 5 Age:

By Clicking Yes, you hereby agree to authorize Catholic Social Service to inquire about your residency, public benefits, and income with the Guam Mayor's Council, Department of Public Health & Social Services, or other agency for qualification. *

Yes, I agree

Child 3 Name

Relationship to Child/Children: *

Mother

Father

Legal Guardian

Please list any additional children's name, age, and school here.

Mailing Address *

Child 1 School: *

Child 3 School:

Email: *

Child 1 Age: *

Child 1 Name *

Child 4 Age:

Child 3 Age:

Child 2 Name

Child 5 Name

Phone *

Household Income ($) *

Your name: *

Number of Children *

Upload Mayor's Verification *