Assistant Director SACC - Part Time ~ Split Shifts

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COMING SOON!!!

Sign-Up is currently CLOSED! Thanksgiving Sign-Up will be live in mid Summer

For questions and concerns please contact Nelly Cerda

COMING SOON!!!

Sign-Up is currently CLOSED! Holiday Assistance Sign-Up will be live in mid Summer

For questions and concerns please contact Nelly Cerda

PLEASE REVIEW AND COMPLETE:

In order for us to provide School Supply Assistance, this sign-up form MUST be completed and submitted with all required documentation.

For questions and concerns please contact Nelly Cerda

School Supply Sign-Up

Back to School Sign Up Form

School Supply Sign-Up 2022

This year we are happy to announce that we will be accepting applications for 2022-2023 school supplies for the following school districts; Mechanicville, Waterford, Stillwater, and Hoosic Valley. You must provide your child's exact school supply list to the community center in addition to the application below no later than Friday, August 19th, 2022. NO APPLICATIONS WILL BE ACCEPTED WITHOUT A SUPPLY LIST. Pick ups will be held Thursday August 25th 2022 between 10AM-2PM.

Email(Required)

Enter Email Confirm Email

Parent Information

Legal Parent/Guardian Name:(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:(Required)

Proof of Residency(Required)

Proof of residency example: Utility bill, report card, letter from school..

Drop files here or

Max. file size: 16 MB.

How many children will need School Supply Assistance?(Required)

Student Information

Please complete the Student Information section below providing Student Information for each child/student that will need assistance with school supplies for the 2022-2023 school year. Please provide School Supply list for each child/student with the items/supplies you do NOT need help with crossed off.

Student 1 Name(Required)

First Last

Date of Birth(Required)

Age:(Required)

Gender(Required)

Male

Female

Prefer Not to Answer

Grade:(Required)

School District:(Required)

Mechanicville Public School

Stillwater Central School

Hoosic Valley Central School

Waterford-Halfmoon UFSD

Other

Does your child need a backpack?(Required)

Backpacks are in shorter supply, so if you received one last year and its in good condition please do not request one this year. Thank you for understanding.

Yes

No

School List:(Required)

Please provide a school supply list: If you do not provide a specific list, we will give you grade appropriate supplies. In an effort to help more of our community's students, please cross off the items on your child's list that you do NOT need help with. Thank you for your assistance.

Max. file size: 16 MB.

Student 2 Name

First Last

Student 2 Date of Birth

Student 2 Age:

Student 2 Gender

Male

Female

Prefer Not to Answer

Student 2 Grade:

Student 2 School District:

Mechanicville Public School

Stillwater Central School

Hoosic Valley Central School

Waterford-Halfmoon UFSD

Other

Does Student 2 need a backpack?

Backpacks are in shorter supply, so if you received one last year and its in good condition please do not request one this year. Thank you for understanding.

Yes

No

Student 2 School List:

Please provide a school supply list: If you do not provide a specific list, we will give you grade appropriate supplies. In an effort to help more of our community's students, please cross off the items on your child's list that you do NOT need help with. Thank you for your assistance.

Max. file size: 16 MB.

Student 3 Name

First Last

Student 3 Date of Birth

Student 3 Age:

Student 3 Gender

Male

Female

Prefer Not to Answer

Student 3 Grade:

Student 3 School District:

Mechanicville Public School

Stillwater Central School

Hoosic Valley Central School

Waterford-Halfmoon UFSD

Other

Does Student 3 need a backpack?

Backpacks are in shorter supply, so if you received one last year and its in good condition please do not request one this year. Thank you for understanding.

Yes

No

Student 3 School List:

Please provide a school supply list: If you do not provide a specific list, we will give you grade appropriate supplies. In an effort to help more of our community's students, please cross off the items on your child's list that you do NOT need help with. Thank you for your assistance.

Max. file size: 16 MB.

Student 4 Name

First Last

Student 4 Date of Birth

Student 4 Age:

Student 4 Gender

Male

Female

Prefer Not to Answer

Student 4 Grade:

Student 4 School District:

Mechanicville Public School

Stillwater Central School

Hoosic Valley Central School

Waterford-Halfmoon UFSD

Other

Does Student 4 need a backpack?

Backpacks are in shorter supply, so if you received one last year and its in good condition please do not request one this year. Thank you for understanding.

Yes

No

Student 4 School List:

Please provide a school supply list: If you do not provide a specific list, we will give you grade appropriate supplies. In an effort to help more of our community's students, please cross off the items on your child's list that you do NOT need help with. Thank you for your assistance.

Max. file size: 16 MB.

Student 5 Name

First Last

Student 5 Date of Birth

Student 5 Age:

Student 5 Gender

Male

Female

Prefer Not to Answer

Student 5 Grade:

Student 5 School District:

Mechanicville Public School

Stillwater Central School

Hoosic Valley Central School

Waterford-Halfmoon UFSD

Other

Does Student 5 need a backpack?

Backpacks are in shorter supply, so if you received one last year and its in good condition please do not request one this year. Thank you for understanding.

Yes

No

Student 5 School List:

Please provide a school supply list: If you do not provide a specific list, we will give you grade appropriate supplies. In an effort to help more of our community's students, please cross off the items on your child's list that you do NOT need help with. Thank you for your assistance.

Max. file size: 16 MB.

School Supplies Assistance Program Disclaimer

I agree to participate in the School Supplies Assistance Program through the Mechanicville Area Community Services Center. I understand that submission of this application does not guarantee provision of all school supplies on my child's list. I understand that orders are filled out on a first-come, first-serve basis. I understand that my child may not receive the same supplies as other children, and that some supplies may not be available.

By checking this box below, I understand and agree to the aforementioned disclaimer.(Required)

Yes, I agree

No, I do not wish to participate

Date of application:(Required)

PLEASE REVIEW AND COMPLETE:

In order for us to evaluate your need, you MUST complete this General Intake Form.

For questions and concerns please contact Nelly Cerda

PLEASE REVIEW AND COMPLETE:

In order to reserve MACSC facility this Facility Use Request Form MUST be completed.

For questions and concerns please contact Carrie Pane

Facility Request Form

General Information

Email

Enter Email Confirm Email

Name of Group/Person:(Required)

Organization:

Contact Person:(Required)

First Last

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Program Name/Type:

Requested Date(Required)

Start Time:(Required)

:

End Time:(Required)

:

Is the program open to the public?(Required)

Yes

No

Does your program require advanced registration?(Required)

Yes

No

Are there fees associated with your program?(Required)

Yes

No

Facility Rental Agreement

Name(Required)

First Last

Date(Required)

Facility Rental Guidelines

Consent(Required)

I agree to MACSC Facility Rental Guidelines

All surface areas in rental rooms must be clean of debris and wiped down if applicable.

All floors in rental rooms must be swept clean of debris and washed if applicable. This includes the kitchen area, tables and chairs. Tables and chairs should be neatly stacked and returned to their locations.

Garbage must be removed from all rental rooms and placed in the outdoor garbage receptacle & recycling.

Please respect MACSC space. If you have signed up to use a particular part of the building, please be sure to keep your guests, children and colleagues in that part of the building. This is to ensure safety for all.

As the responsible individual for the rental party as outlined in the FACILITY REQUEST FORM and THE FACILITY RENTAL AGREEMENT, I have read and understand the following conditions of rental for the Mechanicville Area Community Services Center facility and/or grounds.

Name(Required)

First Last

Date(Required)

PLEASE REVIEW: Rates + Site Locations

Before/After Care and half days will be held onsite at School locations.

MACSC Site Locations
Mechanicville Elementary School (housed at the MES for its 3^rd School Year)
Runs: Sept – June
Hours: AM 7:00 a.m. – 9:00 a.m. | PM 3:00 p.m. – 5:30 p.m.
Accepts: 1st thru 6th grade (ages 6 – 13)

Hoosic Valley School
Runs: Sept – June
Hours: AM No AM Care offered | PM 2:15 p.m. – 5:30 p.m.
Accepts: Kindergarten thru 6th grade (ages 5 – 13)

2022-2023 SACC School Year Rates
Single Child
$14.00/day (AM Care)
$17.00/day (PM Care)
$22.00/day (AM + PM Care)

Sibling Discount
2nd child discount
$10.50/day (AM Care)
$12.75/day (PM Care)
$16.50/day (AM + PM Care)

About Karin Drosdick

MACSC Senior’s Care – Living Well Program Director has extensive experience working with the senior population. She has a wealth of knowledge about Senior Services and can help you navigate the support services out there for your particular needs. If you would like to meet with Karin please call to schedule an appointment.

She is also coordinating programming at the Mechanicville Senior Center for activities and social opportunities for our area seniors. These activities are FREE for seniors and no membership is required. Come down to the Senior Center for a tour and information about all our programming, or call the Mechanicville Senior Center at 518-664-7877.

PLEASE REVIEW: Rates + Information

2022 SACC Summer Camp Information
Runs: Tues, July 5th – Fri, August 26th | Hours: 7:00 a.m. – 5:00 p.m.
Accepts: Kindergarten thru 6th grade (K-6 ages 5 – 13)
Required Documentation: Completed Registration and Copy of child’s Immunization Records

2022 SACC Summer Camp Rates
Single Child
$46/day – $230.00/week

Sibling Discount
$34.50/day – $ 172.50/week (2nd child discount)
$30.67/day – $ 153.35/week (3rd child discount)

	YES, Client Plans to self-resolve	YES, Client agreeable to referral	NO
1. In the last 12 months, did you ever eat less than you felt you should because there was not enough money for food?
2. In the last 12 months, has your utlity company shut off your service for not paying your bills?
3. Are you worried that in the next 2 months you may not have stable housing?
4. Do problems getting childcare make it difficult for you to work or study (if no children, please select N/A)
5. In the last 12 months, have you needed to see a doctor, but could not because of cost?
6. In the last 12 months, have you ever had to go without health care because you did not have a way to get there?
7. Do you ever need help reading hospital materials?
8. Are you afraid you might be hurt in your apartment building or house?
9. Have you seen a primary care provider in the last 12 months?
10. Are you currently enrolled in Medicaid Managed Care Plan with an “active” status
11. Do you require assistance accessing your prescriptions?