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11451 Braddock Road, Fairfax VA 22030
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Welcome! We are so happy you found the Fairfax Church Resource Center. We provide resources to Community Professionals working directly with families who need immediate support. If you are a professional and currently need to obtain resources for a family, we want to support you.
Professional Information
(Required)
First Name
Last Name
What type of agency do you work for?
(Required)
Please Select
Department of Family Services
FCPS
JDRDC
HLO
Fairfax County Police Department
Fairfax County Health Department
Nonprofit Organization
Other
You must work for a nonprofit, school, or government service agency.
Name of school, agency, or organization
(Required)
Professional Email Address
(Required)
Cell Phone Number
(Required)
What is the best way to contact you?
(Required)
Please select
Email
Call
Text
Client Information
Thank you for all that you do to support the most vulnerable families in our community. PLEASE DO NOT COMBINE REQUESTS ONTO ONE FORM. ONE REQUEST PER FAMILY.
What is the zip code or neighborhood that your client lives in?
(Required)
If this is one of several orders you will be submitting for pick up on the same day, is there an identifier that we can use to help separate your donation pick up, (ie, "family initials)?
Family demographic
Tell us about family demographic so we can best assemble resources for them.
How many males ages 11+ are in the family?
(Required)
How many females ages 11+ are in the family?
(Required)
How many children ages 0 to 36 months are in the family?
(Required)
How many children ages 3 to 10 years are in the family?
(Required)
How can we assist you today?
Please check most immediate needs that apply.
Groceries
Non-perishable food for a week (breakfast, lunch, and dinner)
Microwave only bag: non-perishable food for a week (breakfast, lunch, and dinner)
Perishable Bag
Refrigerator Bag: milk, eggs, bread, fruits, and vegetables
Frozen Bag: frozen vegetables
Kitchen Essentials
Regular Bag: flour, sugar, oil, and salt
Culturally Appropriate Bag - Central America: Maseca, Goya brand items
Household and Hygiene
Household Essentials: toilet paper, paper towels, dish soap, hand soap, laundry detergent, cleaning wipes
Hygiene Supplies: shampoo, conditioner, body wash, deodorant, toothbrush, toothpaste
Feminine Products
How many females are in need of feminine products?
(Required)
Please select
1
2
3
4
5
What type of products do you need?
(Required)
Pads
Tampons
Baby Essentials
Baby Food
Baby Formula
Baby Diapers
Baby Food
How many children need STAGE 1 baby food (4 to 6 months old)?
(Required)
NONE
1
2
3
How many children need STAGE 2 baby food (7 to 10 months old)?
(Required)
NONE
1
2
3
Baby Formula
What kind of formula does the family need? (Member's Mark brand)
(Required)
Members Mark Infant compares to Enfamil Premium Infant
Other
Please specify other brand of formula
Diapers
What size of diaper do the children in this household wear?
(Required)
Newborn diapers
SIZE 1 diapers
SIZE 2 diapers
SIZE 3 diapers
SIZE 4 diapers
SIZE 5 diapers
SIZE 6 diapers
Pull-ups
How many children are in NEWBORN diapers?
(Required)
Please select
1
2
3
How many children are in SIZE 1 diapers?
(Required)
Please select
1
2
3
How many children are in SIZE 2 diapers?
(Required)
Please select
1
2
3
How many children are in SIZE 3 diapers?
(Required)
Please select
1
2
3
How many children are in SIZE 4 diapers?
(Required)
Please select
1
2
3
How many children are in SIZE 5 diapers?
(Required)
Please select
1
2
3
How many children are in SIZE 6 diapers?
(Required)
Please select
1
2
3
Pull-ups size
(Required)
2T-3T (16-34 lbs)
3T-4T (32-40 lbs)
4T-5T (38-50 lbs)
5T-6T (46-60 lbs)
7T (65 lbs+)
How many children are in need of pull-ups size 2T-3T (16-34 lbs)?
(Required)
Please select
1
2
3
How many children are in need of pull-ups size 3T-4T (32-40 lbs)?
(Required)
Please select
1
2
3
How many children are in need of pull-ups size 4T-5T (38-50 lbs)?
(Required)
Please select
1
2
3
How many children are in need of pull-ups size 5T-6T (46-60 lbs)?
(Required)
Please select
1
2
3
How many children are in need of pull-ups size 7T (65 lbs+)?
(Required)
Please select
1
2
3
Children's Clothing 0-16 YEARS
Is the family in need of children's clothing (0-16yrs)?
(Required)
No
Yes
How many children are in need of clothing?
(Required)
Please select
1
2
3
4
5
Child #1
What is the age of the child?
(Required)
Gender
(Required)
Boy
Girl
Season
(Required)
Spring/Summer
Fall/Winter
Size
(Required)
Please select
Size: 0-3 months
Size: 3-6 months
Size: 6-9 months
Size: 9-12 months
Size: 12-18 months
Size: 18-24 months
Size: 2T
Size: 3T
Size: 4T
Size: 5T
Size: 6
Size: 8
Size: 10/12
Size: 14/16
Child #2
What is the age of the child?
(Required)
Gender
(Required)
Boy
Girl
Season
(Required)
Spring/Summer
Fall/Winter
Size
(Required)
Please select
Size: 0-3 months
Size: 3-6 months
Size: 6-9 months
Size: 9-12 months
Size: 12-18 months
Size: 18-24 months
Size: 2T
Size: 3T
Size: 4T
Size: 5T
Size: 6
Size: 8
Size: 10/12
Size: 14/16
Child #3
What is the age of the child?
(Required)
Gender
(Required)
Boy
Girl
Season
(Required)
Spring/Summer
Fall/Winter
Size
(Required)
Please select
Size: 0-3 months
Size: 3-6 months
Size: 6-9 months
Size: 9-12 months
Size: 12-18 months
Size: 18-24 months
Size: 2T
Size: 3T
Size: 4T
Size: 5T
Size: 6
Size: 8
Size: 10/12
Size: 14/16
Child #4
What is the age of the child?
(Required)
Gender
(Required)
Boy
Girl
Season
(Required)
Spring/Summer
Fall/Winter
Size
(Required)
Please select
Size: 0-3 months
Size: 3-6 months
Size: 6-9 months
Size: 9-12 months
Size: 12-18 months
Size: 18-24 months
Size: 2T
Size: 3T
Size: 4T
Size: 5T
Size: 6
Size: 8
Size: 10/12
Size: 14/16
Child #5
What is the age of the child?
(Required)
Gender
(Required)
Boy
Girl
Season
(Required)
Spring/Summer
Fall/Winter
Size
(Required)
Please select
Size: 0-3 months
Size: 3-6 months
Size: 6-9 months
Size: 9-12 months
Size: 12-18 months
Size: 18-24 months
Size: 2T
Size: 3T
Size: 4T
Size: 5T
Size: 6
Size: 8
Size: 10/12
Size: 14/16
Other requests
Hidden
Is the family in need of coats?
No
Yes
How many coats do you need?
(Required)
Please select
1
2
3
4
5
6
7
8
9
10
Coat#1: Gender
(Required)
Male
Female
Coat#1: Age
(Required)
Coat#1: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#2: Gender
(Required)
Male
Female
Coat#2: Age
(Required)
Coat#2: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#3: Gender
(Required)
Male
Female
Coat#3: Age
(Required)
Coat#3: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#4: Gender
(Required)
Male
Female
Coat#4: Age
(Required)
Coat#4: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#5: Gender
(Required)
Male
Female
Coat#5: Age
(Required)
Coat#5: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#6: Gender
(Required)
Male
Female
Coat#6: Age
(Required)
Coat#6: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#7: Gender
(Required)
Male
Female
Coat#7: Age
(Required)
Coat#7: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#8: Gender
(Required)
Male
Female
Coat#8: Age
(Required)
Coat#8: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#9: Gender
(Required)
Male
Female
Coat#9: Age
(Required)
Coat#9: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Coat#10: Gender
(Required)
Male
Female
Coat#10: Age
(Required)
Coat#10: Size
(Required)
Please select
Size 0-3 months
Size 3-6 months
Size 6-9 months
Size 9-12 months
Size 12-18 months
Size 18-24 months
Size 2T
Size 3T
Size 4
Size 5
Size 6
Size 7
Size 8
Size 10
Size 12
Size 14
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Are there senior adults (age 65+) in the household in need of adult diapers?
No
Yes
Gender of the adult in need of adult diapers.
(Required)
Male
Female
Adult diaper size
(Required)
Small
Medium
Large
XLarge
XXLarge
To assemble donations best adapted to this family, is there anything else we should be aware of or other requests we might be able to provide?
Donation Pick-up
The Resource Center is open for you Sunday through Thursday 9:00am – 5:00pm, by appointment only.
Select your pick-up date and time below:
(Required)
The person picking up the donations should be the same professional filling out this form unless you specifically make other arrangements with the Resource Center team. We currently do not have a delivery system.
Do you need someone to call you about retrieving your donations?
(Required)
No, I will pick up the items at the date and time selected.
Yes, I need to make other arrangements.
Please confirm below:
Comments
This field is for validation purposes and should be left unchanged.
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LOGIN
About
Vision & Mission
Children’s Ministry
Student Ministries
College Ministry
Fairfax Worship
Fairfax Español
Accessibility
Open Positions
Trellis Internship
Next Steps
New Here? Start Here!
Small Groups
Community Care
Serve With Us
Baptism
Child Dedication
Local Outreach
Global Outreach
Events
All Events
Camp Grow
Watch
Join Us Live
Past Sermons
Give Now
Got a Minute?