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*Only one application per household*
Please complete all requested information for household members. Put NA in required fields where applicable. Date of birth is required for all family members listed; otherwise, leave blank.

All pages must be completed for the application to be accepted. Incomplete applications will not be considered.

You must see this message to have fully completed your application: "Your form has been successfully submitted. Thank you for your time."

Any communication concerning your application and/or possible adoption will be sent to your email provided on the application with HALO as the subject.

Please sign to acknowledge your acceptance and understanding of the above statements.
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Catholic Charities of Ashtabula County Holiday Angels Loving Others (HALO)

Date completing application: (MM/DD/YYYY) * +

Applications will be accepted October 1, 2024 until November 22, 2024 at 5 pm.

Description Text

List all persons in the household starting with the Applicant.

Applicant First Name: *

Applicant Last Name: *

Full SSN: *

Date of Birth (MM/DD/YYYY) * +

Gender: *

Race/Ethnicity: *

Primary Email Address: This is the email address you regularly check. You will receive emails with information regarding your HALO application. This will include any request for further information and updates concerning sharing day. If you do not have an email address please use an email of a trusted friend or family. *

Alternate Email Address: *

Physical Address: *

Apt. #

City: *

Zip Code: *

Is there any source of income for this person in the last thirty days? *

Monthly Household Income $: (Verification required) *

Mailing Address if different than physical address:

Home Phone Number: *

Alternate Phone Number: *

Veteran in household: *

Does anyone else live in your household with you? *

How many people live in the household with the applicant? *