Family Resilience Fund Application

Family Resilience Fund Application

Please click on each tab below to complete the application. Follow the directions carefully. Precise information (such as recent utility bill amounts or reasons for applying) allow for smoother processing for our families.
- Question: What is the Family Resilience Fund?
  
  Answer: The Family Resilience Fund is a fund that provides assistance to adoptive parents, foster parents, kinship caregivers and parents who have previously been in foster care to meet short term needs to allow families to bridge periods of financial instability, allowing parents to focus on creating a stable, permanent home for their children.
  
  Question: Who is eligible for these funds?
  
  Answer: Recipients must be adoptive parents, foster parents, kinship caregivers (caring for minor child who is a family member), or parents who have previously been in foster care. Eligible recipients must be a U.S. Citizen or qualified alien, living with at least one minor child, pregnant, or are the non-custodial parent of a child. The family’s monthly income must be at or below 200 percent of the federal poverty level (FPL). Liquid assets are also considered.
  
  Question: What are the income limits?
  
  Answer:
  
  Question: Are there other specifics about your programs I should know about?
  
  Answer: Yes. The Family Resilience Fund has the following limitations on funding:
  1. Can only be as short-term, emergency funds for the family.
  2. Can only be used up to 3x in a year per family
  3. Must try to exhaust PIPP and/or HEAP benefits for utilities before applying.
  4. Be under a $800 limit (a maximum based on other organizations) for all utility bills.
  5. $2500 maximum disbursement per person (based on previous requests, to ensure equitability for all families).
  6. Food gift cards requests: $100 gift cards per youth age 10 and under, $150 per youth ages 11-17, with a $400 maximum per family ($200 if the family receives SNAP).
  7. Childcare support requires caregiver to have full-time employment (35+ hours/week). They need to provide at least 2 paystubs that show this. The childcare provider must be a licensed provider outside the home.
  8. Clothing can only be for a workplace uniform when beginning a new job and there are no funds to purchase it.
  9. Transportation can only be for to-and-from work via public transportation until the family receives their first pay check.
  Question: How do I apply?
  
  Answer:
  1. Complete the following application in its entirety.
  2. The application must be digitally signed & dated.
  3. Adoption Network Cleveland staff may contact you for more information before approval.
  4. If approved, ALL PAYMENTS, will be made directly to the Vendor(s).
  5. Approval and payment may take anywhere from 2-6 weeks, depending on needs and number of applicants.
  Question: What is the process for approval & payment after I apply?
  
  Answer:
  1. Program staff review the application and uploaded documentation for initial eligibility for the request.
  2. Communication between the applicant and program staff regarding the request and if there is a need for either additional documentation or an updated application to better support the applicant's request.
  3. Landlord verification form is sent for rental requests to verify tenancy; W9s sent and collected from any vendors being paid by check, including landlords and childcare providers.
  4. If not received at time of application, the ODJFS Self-Attestation form is sent, completed in ink, and returned to our office by the applicant.
  5. Application sent for approval by ANC admin.
  6. If approved, funds are disbursed within 1-2 weeks (depending on type of payment); confirmation letter sent to applicant for their records.
  7. A six month check-in call is made by program staff to the applicant to see how the family is doing since fund disbursement.
- Demographics
  
  Please fill out completely and accurately. Be certain to explain what external factors have brought you to applying for this fund today.
- Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number*
  
  Area CodePhone Number
- Email*
  example@example.com
- AdoptiveFosterFormer Foster Youth Currently ParentingKinshipOther
- YesNo
- How did you hear about this fund? *
- This is an emergency fund to help bridge gaps of financial needs. What events have led you to apply for assistance? *
- Have you looked for assistance for this request anywhere else? If so, where?*
- Needs
  
  Eligible families can receive assistance for past-due rent/mortgage, past-due utilities (up to $800), licensed childcare provider (must be full-time employed and will cover up to first full paycheck is made), work uniforms, food (based on need/income loss/age of children) and public transportation to-and-from work (until first full paycheck).
- Provide information regarding each need. Please complete accurately, with current past due balance that appears on your uploaded statement.*
- Adoption/Foster/Kinship Parent Support GroupAdoptive Teen Support GroupHelp regarding school related issuesSupport finding and/or collaborating with my child’s birth family
- Household Members & Income
  
  List everyone in your home including yourself. Income includes: wages from work, child support, public assistance etc. If you do not have income, please read the statement at the beginning of this section.
- I do not individually receive income from any of the following sources: (a) Wages from employment [including commissions, tips, bonuses, fees, pay in lieu of vacation or sick time, profit sharing, etc.]; (b) Income from operation of a business; (c) Rental or royalty income from real or personal property, or gain from the sale of a property; (d) Interest or dividends from assets; (e) Social Security payments, annuities, insurance policy benefits, distributions from retirement funds, pensions, or death benefits; (f) Unemployment or disability payments; (g) Severance pay; (h) Public assistance payments; (i) Periodic allowances such as alimony, child support, or regular periodic gifts received from persons not living in my household; (j) Veteran’s benefits; (k) Gambling winnings; (l) Any other source not named above.
- Number of household members*
  Include yourself, all parents/ legal caregivers of children, other adults in the household, and all children.
- Click + to add more household members. Include yourself & children in the home. *
- Documentation and Proof of Need
  
  Section 1 - Printing & completing at home (if possible).
- Please complete the following steps: (1) print off the form below, (2) fill-in the form completely and accurately in ink, (3) upload this form with your ID and delinquent bills/documents at the bottom of this application. (If you cannot do this from home, you can visit your local library or arrange a time to meet a staff member at our office.) Please note under Step 2, you must check off the number of household members within the chart.
- Documentation and Proof of Need
  
  Section 2 - Uploading documentation for ID & requests.
- Please upload your license/I.D.
  
  Browse Files
  Drivers License, State or Work ID, Etc Cancelof
- Please upload delinquent bills (if applicable), childcare documents, leases, etc. Please make sure these is the most recent bill, and that your name & account number is visible.
  
  Browse Files
  Past due notice/ bills from utility company, lease with amount due per month & landlord's name, bills from childcare provider, etc. Cancelof
- Upload Scanned & Signed Self-Attestation Form Here
  
  Browse Files
  Self-Attestation Form after printing, filling in with ink, and scanning. If you do not have a scanner, we can send directions on how to do it using a smart phone. Cancelof
- I understand that I am required by law to provide my social security number to receive TANF funded benefits/services. This is mandatory under the Social Security Act (42 U.S.C. 1137.)I understand that my Social Security Number will be used to associate all records to my identification including program participation and the receipt of services and benefits.I certify to the best of my knowledge, the information included in this application is true, including income and citizenship/qualified non-citizenship information.I certify that as the parent or legal guardian of the minor child for whom service is being requested, we have not fraudulently received benefits under the OWF and/or PRC programs, OR that we have repaid the cost of any fraudulent assistance as defined in section 5101.83 Revised Code and rule 5101:1-23-75 of the Ohio Administrative Code.I give Adoption Network Cleveland permission to confirm the assistance amount requested through contacting landlords/property managers, utility companies etc.INFORMATION REGARDING YOUR SOCIAL SECURITY NUMBER Generally, if you are applying for TANF services, you must provide the social security number of only those persons you are seeking the benefits for. However, there may be instances where we need the social security numbers of members of the household to verify income or other eligibility criteria to determine eligibility even though they are not seeking TANF services themselves. We may decide that certain members of your family are not eligible for TANF services because, for example, they do not have the right immigration status. If that happens, other family members may still be able to get TANF services if they are otherwise eligible. Social security numbers may be used when contacting appropriate persons or agencies to determine your eligibility and verify information you have given for TANF services; for example, income, disability benefits or other similar benefits and programs. Such information may affect your household eligibility for TANF services. Your social security number may be used for a felony warrant match; a match of persons in violation of probation or parole by law enforcement agencies; or for purposes of investigations, prosecutions, and criminal or civil proceedings that are within the scope of law enforcement agencies’ official duties
- Date
  
  MonthDayYear
  Today's Date
- Type Signature
- Signature
  
  Clear
- *INTERNAL USE ONLY
- YesNo
- ANC staff member completing application
- Should be Empty:

Family Resilience Fund Application

Demographics

Needs

Household Members & Income

Documentation and Proof of Need

Documentation and Proof of Need

*INTERNAL USE ONLY