Refer A Child In Need Do you work with a child in need of clothing and other basic essentials? We’re here to help you! Step 1 of 4 25% Location InformationChoose our closest location*Choose an optionDuval CountyPalm Beach CountyYour InformationPlease make sure you complete this section with “YOUR” information so we can keep you updated with the progress of this referral and contact you if need be. Thank you.First Name*Last Name*Email Address* Phone Number*How would you like to receive notifications?EmailTextBothRelationship to Student*CounselorCase ManagerSocial WorkerTeacher Student InformationPlease make sure to fill out this section fully so we can ensure that care package is delivered to the correct student. Thank youAgency/School Name*Agency/School Zip Code* ZIP Code Homeroom TeacherIf applicableStudent Initials*Student Grade Level*Pre-KindergardenKindergarden1st2nd3rd4th5th6th7th8th9th10th11th12thOtherGender*MaleFemaleOtherStudent Ethnicity*American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteHispanic or LatinoMultiracialStudent Status* Homeless Not Homeless If Homeless, Please Select one of the Following Drop Downs*Living in ShelterLiving With Family MemberLiving in Motel/HotelLiving in vehicle/carother(Need to specify and fix)Please tell us about the student and the background for the request.This will help us to serve the students needs and understand the student's situation.Student Clothing Style Preferences*Is the student a girly-girl? A tomboy? Love the cowboy look? Let us know! Clothing Items NeededPlease work with the family/caregiver to get appropriate sizes and style preferences.Uniform Color(s)Uniforms SizesSize TypeChoose an OptionToddlerYouthJuniors / TeensWomensMensToddler Pants SizesChoose SizeToddler: 2TToddler: 3TToddler Top SizeChoose SizeToddler: 2TToddler: 3TYouth Pants SizesChoose SizeYouth: 4T - XSYouth: 5T - XSYouth: 4 - XSYouth: 5 - XSYouth: 6 - SmallYouth: 6X - SmallYouth: 7 - SmallYouth: 8 -Sm/MediumYouth: XSmall 4-5Youth: Small 6-8Youth: Medium 10-12Youth: Large 14-16Youth: XLarge 18-20Youth Top SizesChoose SizeYouth: 4T - XSYouth: 5T - XSYouth: 4 - XSYouth: 5 - XSYouth: 6 - SmallYouth: 6X - SmallYouth: 7 - SmallYouth: 8 -Sm/MediumYouth: XSmall 4-5Youth: Small 6-8Youth: Medium 10-12Youth: Large 14-16Youth: XLarge 18-20Junior Pants SizesChoose SizeJunior: XSJunior: SJunior: MJunior: LJunior: XLJunior Top SizesChoose SizeJunior: XSJunior: SJunior: MJunior: LJunior: XLWomen Pants SizesChoose SizeWomen's Pants 0Women's Pants 2Women's Pants 4Women's Pants: 6Women's Pants: 8Women's Pants: 10Women's Pants: 12Women's Pants: 14Women's Pants: 16Women's Pants: 18Women's Pants: 20Women's Pants: 22Women's : 24Women Top SizesChoose SizeWomen: 4-5 XSWomen: 6-8 SWomen: 10-12 MWomen: 14-16 LWomen: 18-20 XLWomen: 22-14 XXLWomen: 26-28 XXXLMens Pants SizesChoose SizeMen’s Pants: 28 – 30 SmMen's Pants: 30-32 SmMen's Pants: 34-36 MedMen's Pants: 38-40 LgMen's Pants: 42-44 XLMen's Pants: 46-48 2XLMen's Pants: 50-52 3XLMens Top SizesChoose SizeMen'Shirts:14-14.5 SmMen Shirts:15–15.5 MedMen Shirts:16 -16.5 LgMen Shirts:17-17.5 XLMen Shirts:18 -18.5 2XLMen Shirts:19 -19.5 3XLOutfit Combination 1 x Uniform, 2 Casual Outfits 2 x Uniforms, 1 Casual Outfit 3 x Casual Outfits 3 x Uniforms Select OneUniform Bottoms Select All Bottom: Black Bottom: Khaki Bottom: Navy Blue Select multipleUniform Tops Top: Baby Blue Top: Forest Green Top: Goldenrod Yellow Top: Maroon Top: Navy Blue Top: Red Top: Royal Blue Top: White Top: Black Top: Purple Select 1-3 optionsHygiene ItemsHygiene Items* N/A Body Kit - Soap, Shampoo/Conditioner (Lotion, when available) Dental Kit - Toothbrush, Toothpaste (Floss, when available) Hygiene Items* Body Lotion Deodorant Soap Shampoo/Conditioner Toothbrush/Toothpaste Floss Check all that applyFeminine Hygiene* N/A Pads Only Tampons Only Both Pads/Tampons School Supplies Select All Backpack Pens / Pencils / Paper Composition Notebooks Folders / Binders Gluestick / Art Materials Spiral Notebooks VerificationVerification (The GCP is designed to help students from low income families who qualify for free or reduced lunch. We ask that you check this box as verification that you are requesting items for a student in need whom, to the best of your knowledge, is unable to obtain necessary items needed for success in school)* By checking this box, you verify that you are requesting items for a student in need Family Outreach (In an effort to de-stigmatize situational poverty, The GCP asks that you contact the caregiver of the student in need to make them aware of our organization and the referral you have completed for their child)* By checking this box, you affirm that you will attempt to contact the student's family Pickup or Delivery*DeliveryPickup