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Family Assistance Questionnaire for Winter Coat 
Holmes Middle school  is committed to ensuring that all our students have the resources and support they need throughout the school year to reach their full potential in school and within the community. The questionnaire below is entirely optional and confidential. You only need to complete the questionnaire if you are interested in receiving assistance to address the needs below. Filling out this form is not guaranteed Since we only have limited amount of donated new coat. We may use Lotter if the request exceeds the amount we have.
  If you have any questions about this form, please contact our Family Liaison Ms. Oncho at 571-326-8370 or Email akoncho@fcps.edu
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Email *
Gender  *
Student(s) name *
  Grade(s)  
 *
  Parent(s)/Guardian(s) name(s):  
 *
  What is the best way for us to reach you?  
 *
Please provide your phone number. *
Please provide your Email address  *
  Please check the boxes below  if you need assistance With Coat   
 *
Required
Size *
Other resources
  Also, please know that Fairfax County Coordinated Services Planning is a resource for any family in Fairfax County. They are ready to help you through an assessment by phone to identify the needs you have and link you to resources for which you are eligible. This can include providing basic county information or assisting with more urgent needs such as emergency food, shelter, clothing, healthcare, employment, financial assistance and other essential needs. You can reach Coordinated Services Planning at 703-222-0880, TTY 711 Monday through Friday, 8 a.m. to 4:30 p.m. If you need assistance with your rent, in addition to calling Coordinated Services Planning, you can find more information on the Emergency Rental Assistance program by visiting the Fairfax County Eviction Prevention Website.  
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