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Refer a Student in Palm Beach County
Student Referral - Palm Beach County
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This field is for validation purposes and should be left unchanged.
Your Information
Please make sure you complete this section with “YOUR” information so we can keep you updated with the progress of this referral and contact you if need be. Thank you.
First Name
*
Last Name
*
Email Address
*
Phone Number
*
How would you like to receive notifications?
Email
Text
Both
Relationship to Student
*
Counselor
Case Manager
Social Worker
Teacher
Family Liaison
District Staff
Student Information
Please make sure to fill out this section fully so we can ensure that care package is delivered to the correct student. Thank you
Agency/School Name
*
Agency/School Zip Code
*
ZIP Code
Homeroom Teacher
If applicable
Student Initials
*
Student Grade Level
*
Pre-Kindergarten
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Other
Gender
*
Male
Female
Other
Student Ethnicity
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Hispanic or Latino
Multiracial
Student Status
*
Homeless
Not Homeless
If Homeless, Please Select one of the Following Drop Downs
*
Living in Shelter
Living With Family Member
Living in Motel/Hotel
Living in vehicle/car
other(Need to specify and fix)
Please tell us about the student and the background for the request.
This will help us to serve the students needs and understand the student's situation.
Student Clothing Style Preferences
*
Is the student a girly-girl? A tomboy? Love the cowboy look? Let us know!
Clothing Items Needed
Please work with the family/caregiver to get appropriate sizes and style preferences.
Size/Type
*
Choose an Option
Toddler
Youth
Juniors / Teens (female only)
Womens
Mens
Toddler Pants Sizes (unisex)
Choose Size
Toddler: 2T
Toddler: 3T
Toddler: 4T
Toddler Top Size (unisex)
Choose Size
Toddler: 2T
Toddler: 3T
Toddler: 4T
Youth Pants Sizes (unisex)
Choose Size
Youth: 4T - XS
Youth: 5T - XS
Youth: 4 - XS
Youth: 5 - XS
Youth: 6 - Small
Youth: 6X - Small
Youth: 7 - Small
Youth: 8 -Sm/Medium
Youth: XSmall 4-5
Youth: Small 6-8
Youth: Medium 10-12
Youth: Large 14-16
Youth: XLarge 18-20
Youth Top Sizes (unisex)
Choose Size
Youth: 4T - XS
Youth: 5T - XS
Youth: 4 - XS
Youth: 5 - XS
Youth: 6 - Small
Youth: 6X - Small
Youth: 7 - Small
Youth: 8 -Sm/Medium
Youth: XSmall 4-5
Youth: Small 6-8
Youth: Medium 10-12
Youth: Large 14-16
Youth: XLarge 18-20
Junior Pants Sizes (Teen Girls only)
Choose Size
Junior: 0 - 1 XS
Junior: 3 - 5 S
Junior: 7 - 9 M
Junior: 11 - 13 L
Junior Top Sizes (Teen Girls only)
Choose Size
Junior: 0 - 1 XS
Junior: 3 - 5 S
Junior: 7 - 9 M
Junior: 11 - 13 L
Women Pants Sizes
Choose Size
Women's Pants 0
Women's Pants 2
Women's Pants 4
Women's Pants: 6
Women's Pants: 8
Women's Pants: 10
Women's Pants: 12
Women's Pants: 14
Women's Pants: 16
Women's Pants: 18
Women's Pants: 20
Women's Pants: 22
Women's: 24
Women Top Sizes
Choose Size
Women: 4-5 XS
Women: 6-8 S
Women: 10-12 M
Women: 14-16 L
Women: 18-20 XL
Women: 22-24 XXL
Women: 26-28 XXXL
Bras (Females Only)
Mens Pants Sizes Waist (includes Young Men)
Choose Size
Men’s Pants: 28
Men’s Pants: 29
Men's Pants: 30
Men's Pants: 31
Men's Pants: 32
Men's Pants: 33
Men's Pants: 34
Men's Pants: 35
Men's Pants: 36
Men's Pants: 37
Men's Pants: 38
Men's Pants: 39
Men's Pants: 40
Men's Pants: 41
Men's Pants: 42
Men's Pants: 43
Men's Pants: 44
Men's Pants: 45
Men's Pants: 46
Men's Pants: 47
Men's Pants: 48
Men's Pants: 49
Men's Pants: 50
Mens Pants Sizes Length (includes Young Men)
Choose Size
Men’s Pants: 28
Men’s Pants: 29
Men's Pants: 30
Men's Pants: 31
Men's Pants: 32
Men's Pants: 33
Men's Pants: 34
Men's Pants: 35
Men's Pants: 36
Men's Pants: 37
Men's Pants: 38
Men's Pants: 39
Men's Pants: 40
Men's Pants: 41
Men's Pants: 42
Men's Pants: 43
Men's Pants: 44
Men's Pants: 45
Men's Pants: 46
Men's Pants: 47
Men's Pants: 48
Men's Pants: 49
Men's Pants: 50
Mens Top Sizes (includes Young Men)
Choose Size
Men'Shirts:14-14.5 Sm
Men Shirts:15–15.5 Med
Men Shirts:16 -16.5 Lg
Men Shirts:17-17.5 XL
Men Shirts:18 -18.5 2XL
Men Shirts:19 -19.5 3XL
Underwear (Male or Female)
Choose Size
YES
NO
Size determined based on previous selections.
Socks (Male or Female)
Choose Size
YES
NO
Size determined based on previous selections.
Shoes (Male or Female)
Choose Size
Shoes: Toddler 05
Shoes: Toddler 06
Shoes: Toddler 07
Shoes: Toddler 08
Shoes: Toddler 09
Shoes: Toddler 10
Shoes: Children 01
Shoes: Children 01.5
Shoes: Children 02
Shoes: Children 02.5
Shoes: Children 03
Shoes: Children 03.5
Shoes: Children 04
Shoes: Children 04.5
Shoes: Children 05
Shoes: Children 05.5
Shoes: Children 06
Shoes: Children 10
Shoes: Children 11
Shoes: Children 12
Shoes: Children 13
Shoes: Men 07
Shoes: Men 07.5
Shoes: Men 08
Shoes: Men 08.5
Shoes: Men 09
Shoes: Men 09.5
Shoes: Men 10
Shoes: Men 10.5
Shoes: Men 11
Shoes: Men 11.5
Shoes: Men 12
Shoes: Men 12.5
Shoes: Men 13
Shoes: Men 13.5
Shoes: Men 14
Shoes: Women 06
Shoes: Women 06.5
Shoes: Women 07
Shoes: Women 07.5
Shoes: Women 08
Shoes: Women 08.5
Shoes: Women 09
Shoes: Women 09.5
Shoes: Women 10
Shoes: Women 10.5
Shoes: Women 11
Outfit Combination
1 x Uniform, 2 Casual Outfits
2 x Uniforms, 1 Casual Outfit
3 x Casual Outfits
3 x Uniforms
Select One
Uniform Bottoms
Select All
Bottom: Black
Bottom: Khaki
Bottom: Navy Blue
Select multiple
Uniform Tops
Select All
Top: Baby Blue
Top: Forest Green
Top: Goldenrod Yellow
Top: Maroon
Top: Navy Blue
Top: Red
Top: Royal Blue
Top: White
Top: Black
Top: Purple
Select 1-3 color choices
Hygiene Items
Hygiene Kits
Body Kit - Soap, Shampoo/Conditioner (Lotion, when available)
Dental Kit - Toothbrush, Toothpaste (Floss, when available)
None
Hygiene Items
Body Lotion
Deodorant
Soap
Shampoo/Conditioner
Toothbrush/Toothpaste
Floss
None
Individual items if needed
Feminine Hygiene
Pads Only
Tampons Only
Both Pads/Tampons
None
Verification
Verification (The GCP is designed to help students from low income families who qualify for free or reduced lunch. We ask that you check this box as verification that you are requesting items for a student in need whom, to the best of your knowledge, is unable to obtain necessary items needed for success in school)
*
By checking this box, you verify that you are requesting items for a student in need
Family Outreach (In an effort to de-stigmatize situational poverty, The GCP asks that you contact the caregiver of the student in need to make them aware of our organization and the referral you have completed for their child)
*
By checking this box, you affirm that you will attempt to contact the student's family
Location Information
Choose our closest location. *
- Select
Duval County
Palm Beach County
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