Urbandale Community Action Network

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Back to School 2022 Registration Form

Directions

If you have not filled out a new client form in 2022, please do so here: https://urbandalenetwork.org/new-client-application/

*Your school supply application will not be approved without a new client form.

Do you live in Urbandale

YesNo, please contact UCAN prior to completing this application

Parent Name

Email Address

Phone

Enter Child Name #1

Select Grade

Enter School

Enter Child Name #2 (If applicable)

Select Grade

Enter School

Enter Child Name #3 (If applicable)

Select Grade

Enter School

Enter Child Name #4 (If applicable)

Select Grade

Enter School

Enter Child Name #5 (If applicable)

Select Grade

Enter School

Enter Child Name #6 (If applicable)

Select Grade

Enter School

Back to School 2022 Registration Form

urbandalecan June 28, 2022June 28, 2022 News

← Halloween Fundraiser

The Urbandale Community Action Network (UCAN) is a 501(c)(3) nonprofit organization citizen group providing leadership and ongoing support for comprehensive community-based action to improve the quality of life in Urbandale.

Mailing Address: UCAN P.O. Box 7615
Urbandale, IA 50323

Administrative Office: 3600 75th St. Urbandale, 50322

PHONE: (515) 334-2632
FAX: (515) 278-3931

info@urbandalenetwork.org

UCAN adheres to the USDA Non-Discrimination Policy

https://www.usda.gov/non-discrimination-statement