Financial Assistance Nomination Form

Financial Assistance Nomination Form

Crossroads Kids Club maintains a benevolence fund to help meet basic needs of children, families and volunteers involved in Crossroads Kids Club. Please use this form to nominate a person or family to receive help.
Your Name*

First NameLast Name
E-mail:*
Phone Number:*

Area CodePhone Number
Your connection to Crossroads*
Name of Nominee:*
Location of Nominee:*
City and State
Nominee's relationship to Crossroads*
What have you identified the need to be?*
Please describe the need in detail.*
What caused you to identify this nominee's need?*
How are you hoping Crossroads can help?*
Thank you for your desire to help meet practical needs in your community! A member of our team will get back to you soon after submitting this form if additional information is required for a decision. If no additional information is requested, please expect a decision within one week.
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