Shoes for Kids Application

Name of Parent/Guardian:

Is adult applicant a:
Parent (or) Guardian

Select Date:

Contact Telephone #:

Address:

City:

State/Zipcode:

Qualifications: Attending a Kewanee School in PreK-6th grade at Headstart, Lyle, Belle Alexander, Irving, Central.

Must meet income guidelines (check with KAUW for guidelines).

Note: 3 pairs per family

Child Name:

School attending in the fall:

Age:

Grade:

Shoe size: (include Y or Adult) (shoes are not returnable so please be sure of size)

Gender

Verification Code