Backpack Project Application

Back Pack Project Application

This program is open to children in Brown County and serves students K-12 only. This application must be received in our office by July 15, 2024. Assistance will be determined based upon the date of the returned application on a first come first serve basis.

Pick up Options

I will pick up my child’s backpack at the New Ulm Civic Center on August 1, 2024 between 8 am - 5 pm

I will make arrangements with my child’s school to pick up my child’s backpack.

PARENT/ GUARDIAN INFORMATION

Name

DOB

Spouse/Significant Other

DOB

Mailing Address

City

State

Zip Code

Cell Phone

Have you received Back-to-School assistance from us in the past?

Yes

When:

Household Information

Total number of family members in the household

Adult Male

Adult Female

Children

Is anyone in the household a Veteran?

Yes

Who?

Do you receive free or reduced school lunches?

Yes

Monthly Gross Household Income: (enter numbers)

Employment

Unemployment/Other Income

SSI/SSDI

MFIP/GA

SNAP

Student #1

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

Is there another child?

Yes

Student #2

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

Is there another child?

Yes

Student #3

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

Is there another child?

Yes

Student #4

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

Is there another child?

Yes

Student #5

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

Is there another child?

Yes

Student #6

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

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