Please complete the application below for each eligible client. Applications are due as soon as possible, but no later than Monday, November 22, 2021. Once you submit the form, you will receive a copy of the application via email for your records.
As the staff member submitting this form on behalf of your client, you are responsible for shopping for your client’s gifts in the Community Room in the Langhorne office during the week of December 13, 2021. We will email you when you can sign up for shopping time slot(s).
If you have any questions, please contact Anne Marie Richards at email@example.com or 215-757-6916, ext. 218. Thank you.