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DEPARTMENT OF PUBLIC SOCIAL SERVICES

VP AAF-27 (REV. 07/2017) SPONSOR INFORMATION Please complete the following (please print clearly): Individual Company/Organization Group _____ Last Name First Name Middle Initial Address:_____ Street City Zip Code Contact Person (Group/Organization Only): _ Last First Telephone Number: ( ) _____ Fax Number: ( ) _____ E-Mail: _____ How did you hear about the Program?_____ 1. Would like to sponsor a family that resides in: (indicate desired geographic location) San Gabriel Valley East Los Angeles West Los Angeles Central LA-Hollywood Pomona Valley San Fernando Valley Lancaster-Canyon Country South Los Angeles South Bay-Long Beach Southeast County ( South Gate, Norwalk, Commerce) Pasadena, Glendale, Burbank NO preference, would like to donate where most needed.

VP AAF-27 (REV. 07/2017) SPONSOR INFORMATION Please complete the following (please print clearly): If County employee, please indicate Department/Division/Section:

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