You must have a signed note to pick up for someone else. There can be more than one family unit in a single residence. Some homes have multiple families residing at the same address. Please provide information about YOUR particular family unit.Local Checks' can be picked up on 12/17/24 at the LEKT Food Pantry with a Holiday Food Box (Turkey or Ham, and Dairy Items). $200 Check - Local Enrolled 18+ members with zero minor children. & Enrolled LEKT Members who live out of LEKT Service Area will be mailed on 12/16/24.$200 Check - Local Enrolled 18+ members with zero minor children. Enrolled LEKT Members who live out of the LEKT Service Area. Out of area checks will be mailed on 12/16/24.$400 Check - Local enrolled 18+ LEKT member with families of 4 or less, with primary custody of at least one child under the age of 18.$600 Check - Local enrolled 18+ LEKT member with families of 5 or more, with primary custody of three or more children under the age of 18. (1 parent w 4 kids, or 2 caregivers with 3+ kids)$100 Gift Card for Local non-LEKT enrolled 18+ caregiver with primary custody of one or more LEKT enrolled children under the age of 18. (Caregivers will be contacted by LEKT Social Services to coordinate disbursal.)Please select your Family Size(Required)Please select your Family SizeLEKT Enrolled with no children under 18 as of 12/15/2024LEKT Enrolled with one/two child under 18 as of 12/15/2024LEKT Enrolled with three or more children under 18 as of 12/15/2024Parent/Relative of a LEKT Enrolled Child under 18 as of 12/15/2024LEKT Applicant Full Name(Required) First Middle Last Date of Birth(Required) MM slash DD slash YYYY Do you have an address change to report?(Required) Yes No Address Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone(Required)Email Is your Spouse enrolled LEKT?(Required) Yes No Spouse's Name First Middle Last List the Full Name & Ages of child(ren) you have primary custody of along with ages as of 12/15/2024How many child(ren) do you have primary custody of along under the age of 18 as of 12/15/2024012345678Child 1 Name First Last Date of Birth 1 MM slash DD slash YYYY Child 2 Name First Last Date of Birth 2 MM slash DD slash YYYY Child Name 3 First Last Date of Birth 3 MM slash DD slash YYYY Child Name 4 First Last Date of Birth 4 MM slash DD slash YYYY Child Name 5 First Last Date of Birth 5 MM slash DD slash YYYY Child Name 6 First Last Date of Birth 6 MM slash DD slash YYYY Child Name 7 First Last Date of Birth 7 MM slash DD slash YYYY Child Name 8 First Last Date of Birth 8 MM slash DD slash YYYY HiddenComments(Required)Please let us know what's on your mind. 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