Christmas Application

Last Name

First Name

Middle Initial

Phone Number

Email Address

DD214 and proof of income will be collected if selected.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to selection, I understand that false or misleading information in my application, or interview, may result in denial of assistance from the CVMA Chapter 33-2, and will withdraw your ability to participate in any or all fundraisers in the future.

I would like to be contacted for next year as well