07/27/2025
COMMUNITY CONNECTIONS – BACK TO SCHOOL SUPPLY SIGN-UP SHEET
For Grandparents Raising Grandchildren in Clay County, KY
Serving Children: Pre-K through 6th Grade
IMPORTANT NOTICE – PLEASE READ CAREFULLY
This program is only for grandparents with lower-income households who are raising their grandchildren. Qualifying applications will be served first. If any supplies are left over, they will be distributed throughout the school year as needed.
Each qualifying child will receive a backpack filled with school supplies.
All applications must be dropped off in person at:
Community Connections – 112 Richmond Road, Manchester, KY 40962
Applications must be picked up at our office location starting Monday, July 28th
Pick-up Hours: 8:30 AM to 5:00 PM
We require the grandparent and grandchild to be present when dropping off the completed form.
Once applications are submitted, our committee will review them and begin distributing supplies in alphabetical order until school begins.
Supplies are limited – please act quickly.
📞 For questions or more information, call: (606) 658-2276
📝 APPLICATION FORM
Grandparent’s Full Name: _______________________________________
Home Address: _________________________________________________
City: _____________________ Zip Code: ___________
Phone Number (Best Contact Number): ____________________________
Total Number of People Living in the Home: _______
Child’s Information: (One form per child – please fill out for each child you’re applying for)
Child’s Full Name: _____________________________________________
Child’s Age: _______
Child’s Gender (circle one): Male / Female
Grade Entering (Pre-K to 6th): _____________
School Attending (if known): _________________________________
School Supply List Needed for Child’s Grade:
(If you have a supply list from the school, please attach it or copy it below.)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Additional Needs or Notes:
(Please tell us if there’s anything else your grandchild needs to support their education this year.)
__________________________________________________________________
__________________________________________________________________
__________________________
