Family Gift Request

Let us help make Christmas bright

Tell us about your family. Every application is read with care and kept private. The more honest detail you share, the better we can help.

Parent or guardian

Full name *Phone *Email *Street address *City *ZIP code *

Your household

Total people living in your home *Number of adults *

Housing situation *

Your children (18 and under)

Child 1

First name *Age *Boy / Girl / Other Clothing / shoe size

What would make their Christmas special?

Income & support

Employment status *Total household income per month *

Assistance programs you currently receive

Are you getting Christmas help from anywhere else this year?

Your story

Tell us about your family's situation this year *In your own words. There's no wrong answer.Anything that happened recently? (job loss, illness, move, loss of a loved one, disaster)

Who referred you? (optional) Their name / phone (optional)

Proof (optional, but helps)

Upload up to 5 photos or PDFs, like a benefits letter, a school free-lunch letter, or a shelter letter. Only our admin team can see them.

Tap to choose files

Confirm

I confirm everything I shared is true. I understand Simi Valley Community Christmas Shoppe may contact me or my referral to verify, and that false information may lead to my request being declined.