Voucher Request Form

Use this form to request a voucher on behalf of a neighbor in need.

Store Information

🏪 Hours: Monday-Friday 9:30am-4:00pm

ℹ️ Instructions: Neighbors should visit the store and provide their first name, last name, and date of birth at the counter.

Neighbor Information

Used to track voucher eligibility and ensure appropriate intervals between requests.
Item allocation is based on household size. Count all adults in the home.
Item allocation is based on household size. Count all children in the home.
Clothing

Requestor Information

Organization: Huntington

Your name as the staff member or volunteer requesting this voucher
For voucher confirmation and follow-up if needed