Stickhorses Application Form

Date: *

Date of birth of child: *

Date of death of child: *

Name of child: *

Name of person applying for assistance: *

Relation to child: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Contact Telephone: *

Email *

Please share the family's story: *

Please state how the financial assistance is to be used: *

Proof of guardianship (birth certificate or proof of guardianship). By submitting this application, applicant certifies that they had legal custody of the child at the time of their death.
Proof of child's death (obituary or death certificate)
By applying for this assistance you are certifying that all information is true. Should it be determinded that any information is untrue, legal means will be used to recover any funds granted.

Signature *

Clear

Print Name *

Clear

Obituary or Death Certificate *

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Proof of Guardianship *

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Date *

Date

Application Requirements:

Only families that have lost a child birth to 17 years qualify for assistance.
Applications must be submitted within one year of the date of death.

Additional Information:

Stick Horses and Capes may request a video or phone interview once the application is received.
Stick Horses and Capes reserves the right to refuse any application for financial assistance for any reason. Stick Horses and Capes does not guarantee assistance and not all requests will be fulfilled due to limitation of funds. Funding decisions are at the discretion of the Board of Directors of Stick Horses and Capes. Stick Horses and Capes grants applications for financial assistance without discrimination based on race, color, sex, language, religion, or political opinion.
Please scan and email this application as well as proof of guardianship and death certificate to stickhorsesandcapes@gmail.com or mail to P.O. Box 4079, Abilene, Texas 79608

Would your family be willing to share how Stick Horses and Capes helped your family? YES NO*

P.O. Box 4079 ■ Abilene, Texas 79608

stickhorsesandcapes@gmail.com ■ stickhorsesandcapes.org