U.S. Only. This form is subject to validation. Packages may take up to four weeks to ship. We reserve the right to refuse to fulfill your application if you appear suspicious of completing a fraudulent application form. All applications are reviewed and we do our due diligence when deciding if an applicant is eligible for a care package or not.

 Care package availability is dependent upon operating funds and donations.

Care Package Application Form

Care Package Application Form
Select 5-6 items that you would like to recieve:

We ask that all care package applicants submit a photo of themselves or their family, as well as a short testimony. After you receive your package, your photo and testimony will be shared on our social media and website to promote our program and share our impact. 

Upload Photo

Please use complete sentences for the following questions. Your answers need to be longer than just a few words.  

Thanks for submitting!