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
BACK TO SCHOOL CHECK LIST
-

Identify low income families that can benefit from our program and live in the William Floyd Family Centers catchment 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 supplies.

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.

If you have any questions, please call Jessie Caggiano at 631874-1323

FOR OFFICIAL USE ONLY

Appointment Date: __________________
Appointment Time: __________________
Site:

_____________________________

Parents Name & DOB: ____________________________________________________

Address: ____________________________________________________
____________________________________________________
Phone Numbers: ____________________________________________________
Race/Country of Origin: ____________________________________________________
Language Spoken: ____________________________________________________
FSL REFERRAL
REFERRED BY:______________________________________________________
PROGRAM/PHONE:__________________________________________________
th

All forms must be turned in by Friday July 24 . 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/School
District

school
year)

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.

! 1:00 p.m.- 4:00 p.m.

(William Floyd Family Center, Mastic Beach)

! 9:30 a.m.- 12:00 p.m.

! 1:00 p.m.- 4:00 p.m.
! 4:00 p.m.- 7:00 p.m.

(William Floyd Family Center, Mastic Beach)

(William Floyd Family Center, Mastic Beach)

Thursday, August 27th
(William Floyd Family Center, Mastic Beach)
(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.

" 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