English Instructions

U R Special Spring Distribution

March 29-30, 2024

*FRIDAY 1:00 PM* TO 7:00 PM   SATURDAY 10:00 AM TO 1:00 PM

*NEW LOCATION:  Dayspring Church*, 400 N Chowning Ave, Edmond, OK  73034


It’s time for U R Special’s Winter Distribution!  Come get your new outfit!  All children ages 3 through 9 who have an Edmond address or go to an Edmond school are welcome.

* Note our new location and times.  We will now be doing distribution at Dayspring Church, East of the UCO campus.  See our website or Facebook page for more information.  We are also starting later on Friday at 1:00 PM.


  1. Please fill out this income verification form (below) in advance!
  2. Bring this form and a utility bill to prove your Edmond address or a report card (for each child) to verify school enrollment. Electronic versions are OK.
  3. When you arrive, come to the front door and check in. Turn in this form.

Income Verification Form

In order to participate, this form must be completed.


_______________________________________________________    (_____)_______________

Name of Parent or Legal Guardian                                    Cell Phone Number

To be eligible, your annual household income must be less than the dollar amounts below.

Annual household income includes all earnings of all individuals who occupy the home.

Annual Household Income:      $__________________ / year       2 person household - $55,050

3 person household - $61,950

Number of Adults in your Household:  _____                         4 person household - $68,800

Number of Children in your Household:  _____                      5 person household - $74,350

6 person household - $79,850

Is your income less than the table to the right?                   7 person household - $85,350

                YES or NO                                                                   8+ person household - $90,850


Child’s First & Last Name 1st Time? Boy / Girl Age School
   Y  /  N    B  /   G
   Y  /  N    B  /   G
   Y  /  N    B  /   G
   Y  /  N    B  /   G


I certify that the information provided is true and correct.

_________________________________________________    _________________

Parent/Guardian Signature                                             Date


UR Special Representative Initials