2018 Dates

Application deadline: September 16, 2018

Notification of assistance decision – September 23, 2018

The West Georgia Elves mission is to help families of children with serious illnesses that have a financial need due to the child’s illness.

For us to fulfill our mission effectively, we ask that you please fill out the form below.

• Parent/Guardian Name *

• Child with Illness name *

• Other Child name(s) *

• Address *

• Telephone *

• E-mail *

• Own/Rent Home *

  ...OwnRent

• Child's primary (day-to-day) caregiver *

• Household Income *

  ...Below $15k$15k - $30k$30k - $50k$50k - $75k$75k - $100k$100k- $125k$125k - Above

• Do you currently receive SSI? *

  ...NOYESIN PAST, but not now

• Check all illnesses that apply *

  Blindness   Cancer   Cerebral Palsy   Epilepsy   Hydrocephalus   Medically fragile   Muscular dystrophy   Spina Bifida   Wheelchair bound   Other, describe below

• Other illnesses not above

• Child with serious illness picture upload

• Child 2 picture upload

• Child 3 picture upload

• Waiver

  By clicking submit I certify that 1) the above information is true and accurate to the best of my knowledge, and 2) if requesting help with Christmas gifts I certify that I am not requesting assistance from any other agency.