Case Worker Wish Form This form is only for caseworkers of registered partner agencies only This Wish is pending approval by The Wish Project. You will be sent a confirmation.Case Worker InformationCase Worker First Name Case Worker Last Name Agency Program City Email Client InformationClient First Name Client Last Name Client 2 First name Client 2 Last Name Ethnicity - Select -CaucasionAsianHispanicNative AmericanAfrican AmericanFamily Status - Select -HomelessDisaster VictimPeople with DisabilitiesRecovering AddictGrandparent as ParentLow IncomeFoster ParentOtherAdults - Male Adults - Female Children - Boys Children - Girls Wish ItemsFor Full and Queens must have 2 adults in bed. Twins are given to single adults and children over 3. We do not give out just box springs. Please put the number of each bed size you need below.Beds - Baby Beds - Toddler Beds - Twin Beds - Full Beds - Queen Heater / Air Conditioning - Select -HeaterAir Conditioning (Dr Note Required)Household Items Kitchen Table Dresser Sofa Love Seat Household Kits Microwave ClothingKitchen - Chairs Baby Items Car Seat - Infant Car Seat - Toddler Double Stroller New Born Basket Play Mat Swing Baby Bedding Diaper Bag Formula Safety Kit Safety Gate Baby Bottles Baby WipesDiapers - Select -Size 1Size 2Size 3Size 4Size 5Size 6Pull-UpsBirthday Bag - Select -BoyGirlSubmit Form
The Wish Project