BACKPACK APPLICATION 2023

Backpack Application 2023 - Deadline August 11, 2023

ELIGIBILITY__________Must live in Halton Hills (Acton, Georgetown and outskirts)__________Maximum after-tax household income: $28,000 (1-2 people in home); $39,000 (2-4 people in home); $48,000 (5-6 people in home); $52,000 (7+ people in home)

CONTACT Name(Required)

First Last

ADDRESS (must live in the Town of Halton Hills: Acton, Georgetown and outskirts)(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.

SUBMISSION DEADLINE: AUGUST 12, 2022. We will contact you in late Aug/early Sept with pick-up details.

Comments

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