OnLine Application

Detroit Goodfellow Application

Apply for the 2023 Program
Please be assured that your information will be held in strict confidence and will not be shared with any other organization or agency. We will only process applications for families in the following cities - Detroit, Highland Park, Hamtramck, River Rouge, Harper Woods, Ecorse & Redford. At the time of package pickup in December you will be asked to provide parent/guardian ID and ID for kids (MI Health Card OR birth certificate OR report card/communication from child's school). You can provide all ID by showing images in your phone. All eligible families will receive communication from the Detroit Goodfellows in August to confirm your information and again in early December via US mail and email to provide pickup information. Pickup reminders will also be sent via email and text.
Who is filling out this form?*

MotherFatherGuardian
Your Email*

Confirmation Email
Mother's Full Name

First NameLast Name
Father's Full Name

First NameLast Name
Guardian's Full Name

First NameLast Name
Your Address (this is where your confirmation letter will be sent)*

Street Address

Address Continued

CityState

ZIP
Your Cell Phone*

Area CodePhone Number
Please provide the child(ren)'s full name, Gender, Birthdate and MI Health Number. Only Children born between January 1, 2010 and December 31, 2019 will be eligible to receive packages. You can apply for up to eight (8) children on this application. When finished, be sure to click the Submit button at the bottom. By clicking Submit, you agree that the Goodfellows may contact you by email or text.
1st Child's Full Name*

First NameLast Name
Gender*

BoyGirl
Birth Date*

MonthDayYear
MI Health No.*
Another Child?*

YesNo
2nd Child's Full Name

First NameLast Name
Gender

BoyGirl
Birth Date

MonthDayYear
MI Health No.
Another Child?

YesNo
3rd Child's Full Name

First NameLast Name
Gender

BoyGirl
Birth Date

MonthDayYear
MI Health No.
Another Child?

YesNo
4th Child's Full Name

First NameLast Name
Gender

BoyGirl
Birth Date

MonthDayYear
MI Health No.
Another Child?

YesNo
5th Child's Full Name

First NameLast Name
Gender

BoyGirl
Birth Date

MonthDayYear
MI Health No.
Another Child?

YesNo
6th Child's Full Name

First NameLast Name
Gender

BoyGirl
Birth Date

MonthDayYear
MI Health No.
Another Child?

YesNo
7th Child's Full Name

First NameLast Name
Gender

BoyGirl
Birth Date

MonthDayYear
MI Health No.
Another Child?

YesNo
8th Child's Full Name

First NameLast Name
Gender

BoyGirl
Birth Date

MonthDayYear
MI Health No.
Should be Empty:

Detroit Goodfellow Application