Its time for William Floyd Family Centers Backpacks For Back To School!

Here are some key points and instructions to follow for the 2015 referral process.

The event this year will be held

Wednesday August 26th 9:30am4:00pm & Thursday August 27th from 9:30am7:00pm.

Referral forms are due no later than Friday July 24th. Monday , July 18th

Identify low income families that can benefit from our pro-

gram and live in the William Floyd Family Centers catch-ment area.

Attached is a referral form. Please do not leave

anything blank.

You can return this form ASAP but no later than July 24th

to:

Jessie Caggiano

William Floyd Family Center:

Mail: 338 Blanco Drive, Mastic Beach NY 11951

E-mail: jcaggiano@fsl-li.org

Fax : 631-874-1357

by ASAP but no later than Friday July 24th.

Families will be sent a confirmation letter that they will

need to bring on their assigned time to pick up school sup-

plies.

Although we will try to assist everyone with their back to

school needs, supplies may be limited and forms will be pro-

cessed on a first come first serve basis. Any forms received

after capacity is reached will automatically be put on a wait

list and given supplies if available.

If you have any questions, please call Jessie Caggiano at 631-

874-1323

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BACK TO SCHOOL CHECK LIST

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Parents Name & DOB: ____________________________________________________ Address: ____________________________________________________ ____________________________________________________ Phone Numbers: ____________________________________________________ Race/Country of Origin: ____________________________________________________ Language Spoken: ____________________________________________________

All forms must be turned in by Friday July 24th. Although we will try to assist everyone with their back to school needs, supplies may be limited and forms will be processed on a first come first serve basis. Any forms received after capacity is reached will automatically be put on a wait list and given supplies if available.

PLEASE PRINT CLEARLY

Childs First & Last Name Date Of Birth

Gender Grade (for

upcoming

school

year)

School/School

District

DO NOT go to East Yapank Office at 1490 William Floyd Parkway

New Pick up Location: William Floyd Family Center: 338 Blanco Drive, Mastic Beach NY 11951

Preferred Time to Attend Backpack Program

Wednesday, August 26th !! 9:30 a.m.- 12:00 p.m. (William Floyd Family Center, Mastic Beach) !! 1:00 p.m.- 4:00 p.m. (William Floyd Family Center, Mastic Beach)

Thursday, August 27th !! 9:30 a.m.- 12:00 p.m. (William Floyd Family Center, Mastic Beach) !! 1:00 p.m.- 4:00 p.m. (William Floyd Family Center, Mastic Beach) !! 4:00 p.m.- 7:00 p.m. (William Floyd Family Center, Mastic Beach)

Please be advised that we will be cross-referencing our list with other agencies that will be giving out school supplies. You will only be able to sign up with one agency.

FSL REFERRAL

REFERRED BY:______________________________________________________

PROGRAM/PHONE:__________________________________________________

FOR OFFICIAL USE ONLY Appointment Date: __________________ Appointment Time: __________________ Site: _____________________________

" You will be sent a confirmation letter that you must bring to the appointment.

" When you receive this letter, please make sure that all information is correct, including

number of children in the family. Incorrect information, such as family size, will not be corrected the day of the event. NO EXCEPTIONS WILL BE MADE.

" Please be advised that you need to keep your appointment time.

DO NOT go to East Yaphank Office at 1490 William Floyd Parkway

New Pick up Location:

William Floyd Family Center

338 Blanco Drive

Mastic Beach NY 11951

(next to PACA Middle School)

Return form to: Jessie Caggiano 338 Blanco Drive

Mastic Beach NY 11951

Email: Jcaggiano@fsl-li.org Phone: 631-874-1323 Fax: 631-874-1357