Emito Foundation

Christmas Care Relief Form

"*" indicates required fields

The Christmas Care Relief is open to individuals and families in need based in the Greater Houston metropolitan area. The Christmas Care Relief consists of perishable and non-perishable goods provided by Wazobia African Market.


Minimum requirement: Must be based in the Greater Houston metropolitan area. All applicants are required to complete the form below to be considered for the Christmas Care Relief by October 31st.


The information provided on this form will be used by the Committee to select recipients for the Christmas Care Relief. It is important to give complete details concerning your background and financial information.


Are you nominating for you or someone else? **
Nominated by **

BASIC INFORMATION

Please fill out the form completely with the nominee's information for consideration of the Christmas Care Relief.
Name **
Gender *
Marital Status **

Household Income (based annually) **