Application For Assistance

Family Grant Application

Is your family eligible? We help families from birth to 17 years of age. Up to one year after the death of a child. Our family grants can be used for mortgages or bills, therapy, funeral or hospital costs, or what your family needs most at this moment.
Date

MonthDayYear
Date
Full Name of child:*

First NameLast Name
Date of birth of child*

MonthDayYear
Date
Date of death of child*

MonthDayYear
Date
Name of person applying for assistance:*

First NameLast Name
Relation to child:*
Mother's Name

First NameLast Name
Mother's Contact Telephone
Please enter a valid phone number.
Father's Name

First NameLast Name
Father's Contact Telephone
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
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 determined that any information is untrue, legal means will be used to recover and funds granted.
Obituary or Death Certificate*

Cancelof
Birth Certificate*

Cancelof
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.
Would your family be willing to share how Stick Horses and Capes helped your family?

YesNo
Do you give permission for Stick Horses and Capes to share a picture of your child?

YesNo
P.O. Box 4079 ■ Abilene, Texas 79608

stickhorsesandcapes@gmail.com ■ stickhorsesandcapes.org
Signature*

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Printed Name*

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Should be Empty:

Family Grant Application

P.O. Box 4079 ■ Abilene, Texas 79608

stickhorsesandcapes@gmail.com ■ stickhorsesandcapes.org