Project Pencil Case Kit
Registration Applicaton
BACKPACK & SCHOOL SUPPLIES
ON-LINE REGISTRATION APPLICATION
If you have questions or need assistance completing this application
please contact us at (919) 559-9629. You can view the program
guidelines for this program by clicking the link at the bottom of the page.
*
Parent/Caregivers  
Name:
Date:
*
Phone:
*
Address:
City, State, Zip:
My child(ren) are in need of:
(Check all that apply)
Backpack
 School Supplies
Both
Children: Please list name of each child that is in need of
supplies.
Name:
 Age:
 Grade:
School:
Additional comments/special considerations:
By typing my name and date in the boxes below I acknowledge that I
have read, understood and agreed to the guidelines for this program
and authorize my child(ren) to receive school supplies through this
program. I also understand that I will need to complete a formal
application at time of school supply pick up.
Name:
Date:
Project Pencil Case Kit Program Guidelines