2019 Dates

Application deadline: September 15, 2019

Notification of assistance decision – September 22, 2019

If selected for assistance you will be notified and requested to submit detailed information on each of your children.

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.