Request for HELP

Please complete the form below to request assistance for yourself or for someone else. All information provided is kept in strict confidence. Children are eligible up to their 18th birthday, unless the individual is disabled. All applicants should expect the following procedure before receiving assistance:

  • Step one: complete and submit the online form (below)

  • Step two: participate in a scheduled phone call with an intake committee member

  • Step three: show proof of residency (Scituate)

Please feel free to reach us anytime by email at

What type of assistance is being requested? *
For whom are you requesting help:? *
SECTION ONE: Applicant Information
This section is for the person who is completing this form. Section two, below, is where you will input information about the family that is in need of assistance.
Your Name *
Your Name
Please enter your full name.
If you belong to a church, non-profit, or other organization, please list the name below.
SECTION TWO: Family Information
The questions below pertain to the family who is in need of assistance.
Please enter the last name of the family for whom the assistance is being requested.
Head of Household *
Head of Household
Please enter the first and last name of the person who is the head of the household requesting assistance.
Head of Household Address *
Head of Household Address
Head of Household Phone
Head of Household Phone
Please list the names of any schools which children in this family attend.
Please describe the Head of Household's relationship with the children.
Is the Head of Household a Veteran? *
Has this family received support from Scituate Community Christmas in previous years? *
Does the Head of Household have full custody of the children? *
What is the marital status for the Head of Household? *
Does the Head of Household receive child support? *
Select the Head of Household's living arrangements. *
Please check off any assistance programs that are already in effect. *
SECTION THREE: Family Members
For each member in the family, please include: 1. Name, age, and gender. 2. If this is a request for Christmas please include their holiday wish list.