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Dr. Seuss's How The Grinch Stole Christmas!
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ACT Pass Application
Primary Account Name
*
First Name
Last Name
Primary Account Email
*
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Household Size
*
1
2
3
4
5
6
7
8
9
10+
Number of Children under 19 Years of age in household
*
0
1
2
3
4
5
6
7
8+
Is there a single parent in the household?
*
Yes
No
Children's Grade Level
Preschool
K+
3rd+
Middle School
High School
Not Applicable
Select all that apply.
Do you and/or your household qualify for Free and Reduced Lunch or other public assistance programs?
*
Yes
No
Don't Know
Not Applicable
Household Annual Income Level
*
Under $15k
$15 - 24,999
$25 - 34,999
$35 - 44,999
$45 - 54,999
$55 - 64,999
$65 - 79,999
$80k+
(Include income from work, welfare, child support, alimony, pension, social security and disability, and any other sources)
Annual Income
How did you hear about the ACT Pass program?
While household income is a major factor, we recognize other circumstances affect families’ economic realities. Please write a 1-2 sentence statement clarifying your need for economic assistance for CTC Programs this season. You may also inform us of any additional barriers for your family, including transportation, language, and/or special needs.
Please submit your application. Watch the email given above for further information within 7 business days.
Please submit your application. Watch the email given above for further information within 7 business days.
Please submit your application. Watch the email given above for further information within 7 business days.
Please submit your application. Watch the email given above for further information within 7 business days.
Please submit your application. Watch the email given above for further information within 7 business days.
Please submit your application. Watch the email given above for further information within 7 business days.
Email
This field is for validation purposes and should be left unchanged.
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