Backpack Project Application | United Way of the Brown County Area

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Backpack Project Application

Back Pack Project Application

This program is open to children in Brown County and serves students K-12 only. This application must be received in our office by July 18, 2025. Assistance will be determined based upon the date of the returned application on a first come first serve basis.

Pick up Options

I will pick up my child's backpack on July 30 at the New Ulm Civic Center between 8:00 am and 4:00 pm.

I will pick up my child's backpack on July 31 at the New Ulm Civic Center between 8:00 am and 12:00 noon.

PARENT/ GUARDIAN INFORMATION

Name

DOB

Spouse/Significant Other

DOB

Mailing Address

Mailing Address

City

State

Zip Code

Email *

Cell Phone*

Have you received Back-to-School assistance from us in the past?

No

Yes

When:

Household Information

Total number of family members in the household

Adult Male

Adult Female

Children

Is anyone in the household a Veteran?

No

Yes

Who?

Does your child qualify for educational benefits through your child's school? You may need to contact the child's school to obtain the educational benefits form.

Yes

No

Monthly Gross Household Income: (enter numbers)

Employment

$

Unemployment/Other Income

$

SSI/SSDI

$

MFIP/GA

$

SNAP

$

Student #1

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

No

Is there another child?

Yes

No

Student #2

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

No

Is there another child?

Yes

No

Student #3

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

No

Is there another child?

Yes

No

Student #4

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

No

Is there another child?

Yes

No

Student #5

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

No

Is there another child?

Yes

No

Student #6

First Name

Last Name

Grade

School

Male/Female

Male

Female

DOB

Needs a Backpack

Yes

No

Comments:

Signed Consent

Each adult, emancipated minor, or unaccompanied youth must sign for him/herself. A parent or guardian must sign for children under the age of 18. My signature indicates that I consent to you capturing and utilizing all personal information, including Educational Benefits Eligibility, regarding me and my dependents.

Name of Signer

Relationship to Child(ren)

Address: 108 North Minnesota St. New Ulm, MN 56073 Phone: 507-354-6512 Email: admin@uwbrowncounty.org

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