Lagrange County Miracle Tree Christmas Application

Please complete all required fields before submitting.

BEFORE YOU BEGIN

Please enter information carefully and truthfully. If you have more than one child, complete each child section fully so Miracle Tree has the correct sizes, needs, and wish list details. Tap Save and finish later anytime. That save is only good for 7 days, and only on this same device and this same browser. A different phone, a different computer, or a private window will not have it. After 7 days it is gone.

This save only lasts 7 days, and only on this same device and this same browser. Another phone, another computer, or a private window will not bring it back. After 7 days it is erased and you will have to start over.

Applicant Information

Please complete the information below. If a question does not apply, enter N/A.

Name of Applicant*

First

Last

Address*

Lagrange County IN, Steuben County IN, or Sturgis MI only.

Phone*

Include area code.

Alternate Phone

Optional. Enter N/A if not applicable.

Email Address*

We will use this to contact you about your application.

Are You A Citizen Of The USA?*

Yes No

If No, explain below and upload a visa, asylum document, or green card in Required Documents.

If no, please explain

List All Adults In Household

Add each adult in your household. Include employer/self-employment and monthly income amounts. Enter 0 or N/A where applicable.

Children You Have Legal Custody Of

Add each child you have legal custody of.

No Income/Household Survival Questions

If there is no income in your home, please answer these questions. If this does not apply, enter N/A.

Who last worked?*

When did they last work?*

Last check received*

How is the family surviving with no income?*

Consent, Eligibility, and Certification

By signing this application, you are giving Lagrange County Miracle Tree consent to give your names and list of gift ideas for your children to other organizations who may "adopt" your family. They will keep your name confidential. Name WILL NOT be put on trees.

Lagrange County Miracle Tree will NOT be able to help your family if:

You do not live in Lagrange County, IN, Steuben County, IN, or Sturgis, MI.
You do not provide the required documentation or give false information.
Over income.
Did not claim everyone in household or all income in household.
Illegally in United States.
Not enough help for applications received.

I affirm under penalty of perjury that my answers are complete and correct to the best of my knowledge. I am also aware that if I intentionally gave false information or double dip and signed up for multiple Christmas programs my application will be denied, and I may be permanently banned from receiving help.

Digital Signature*

Sign (type) to certify the information is complete and correct. Must match the applicant first and last name.

Date

Authorization to Verify Application

I authorize the Lagrange County Miracle Tree to communicate with the following, in order to verify the accuracy of my application for assistance. This authorization applies to all sources listed below.

Verification authorization sources: Employers/Temp Agencies, Landlord, Division of Family Resources, WIC, Social Security Administration, CANI Trustees, Schools, Police Dept, Toys for Tots, Salvation Army, Other Agencies providing Christmas Assistance.

Name (for verification authorization)*

Date (verification authorization)

Required Documents

Every document listed below is required. State IDs and birth certificates are added automatically as you add adults and children.

Phone photos of IDs and certificates work best, including large families. Each document uploads one at a time. If a PDF is rejected, take a picture of the paper instead.

0 of 0 required documents attached

Please keep watching your email for updates after you submit.

Applications Closed