The Main Place - Christmas Wish List

17th Annual Christmas Wish List Program

Dear Project PASS Students,

We would like to help make this holiday season a blessed one for you. Please fill in all information on the following form. Once you click on “submit,” you will receive an email with your assigned number (such as I-21 or N-12, etc.), and instructions for picking up your gifts.

This form must be submitted no later than October 31st, however we encourage you to complete the form and submit as soon as possible.



Student's First Name:	Student's Last Name:
Campus: Grade:	Email Address:
Age: DOB (mm/dd/yyyy): Gender: Male Female	Verify Email Address:
Race:	Home or Cell Phone #:
Ethnicity:	Student ID #:
Favorite Color(s): Style: Trendy Preppy Casual Retro Other If other:	Student Address: City: State: Zip Code:

Parent / Guardian Name:	Address:
Parent / Guardian Cell:	Apt#:
Parent / Guardian E-Mail:	City: State: Zip Code:


We will not share the above information. It is for our records and internal use only.

GIFTS

Your wish list will be chosen by someone who is looking forward to bringing you joy and who will give you the best gifts they can afford.

GIFT CARDS
Please select up to four (4) gift cards from the following list:

Discount Store

Grocery Store

Fast Food
Dine-In Restaurant

Movie Theater

Big Box Discount Stores such as Walmart or Target or similar stores
Department Stores such as Macy’s or Burlington or TJ Maxx or Kohl’s or similar stores
Gas or Convenience Stores such as QuikTrip or RaceTrac or similar stores

Do you (Project Pass student) have a child or children? Yes No
This question is ONLY about children of the Project PASS student, not his or her siblings.

Your child's name: Gender: Male Female Date of Birth (mm/dd/yyyy):