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Funding Request
Thank you for your application to Step Onward Foundation. Please provide as much information as possible, as it will help our committee make an informed decision in a timely manner. Step Onward is a 501c3 non-profit organization and receives grants and donations to support our programs, and as such, we are required to report demographic information on all individuals we serve. Step Onward does NOT use this information to determine eligibility for services, nor do we discriminate based on age, race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, disability or genetic information.
Application Date
-
Month
-
Day
Year
Today's Date
Is this your first request submitted to Step Onward Foundation?
*
Yes, this is my first request.
No, I've requested funding in the past.
Please enter the recipient information below. Recipients are generally students or patients receiving care at a local hospital.
First Name
Name of student, patient etc
Last Name
Name of student, patient etc
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Female
Male
Non-Binary
Age
Age Group
Race and/or Ethnicity (please select all that apply)
Hispanic or Latino
White
Black or African American
Asian
Middle Eastern or North African
Native Hawaiian or Pacific Islander
American Indian or Alaska Native
Other
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Preferred Language
# of adults in the home
*
# of your dependents under 18 in the home
*
Annual Household Income
*
I am a dependent
Yes
No
Back
Next
Please complete this page for additional household members.
Parent or Caregiver Name
Caregiver First Name
Caregiver Last Name
I am a single parent.
Yes
No
Date of Birth
-
Month
-
Day
Year
Gender
Female
Male
Non-binary
Caregiver 1 Age
Caregiver 1 Age Group
Race and/or Ethnicity (please select all that apply)
Hispanic or Latino
Black or African American
White
Asian
Middle Eastern or North African
Native Hawaiian or Pacific Islander
American Indian or Alaska Native
Other
Parent or Caregiver Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Female
Male
Non-Binary
Caregiver 2 Age
Caregiver 2 Age Group
Race and/or Ethnicity (please select all that apply)
Hispanic or Latino
Black or African American
White
Asian
Middle Eastern or North African
Native Hawaiian or Pacific Islander
American Indian or Alaska Native
Other
Please list any other adults in your home (outside of any caregivers listed), as well as your dependents (other than the patient/student identified on page 1).
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Next
How did you hear about us?
Referring Organization
Dell Children's Hospital
Lifeworks
Presbyterian Children's Home
Depelchin
Star of Hope
Other
Please provide the name and contact info of your social worker or person(s) referring you to us.
*
Name and contact info of the person referring you.
History Of (please select all that apply)
Foster Care
Family Medical Crises
Food Insecurity
Domestic Violence
Juvenile Justice
Substance Abuse
Homelessness or housing insecurity before age 18
Homelessness or housing insecurity after age 18
Refugee
Trafficking
Other
Financial Support Systems (please select all that apply)
Employment
Government Assistance
Student Loans/Grants
Family/Friends
Other Non-profit Funding
Other
Other Current Support Systems
Therapist
Social Worker
Other
Are you in school?
Yes
No
If not, do you have plans to attend school?
Yes
No
Employment
Currently Employed
Actively seeking employment
Other
Employer
Current Job
How long have you been at your job?
Do you currently have transportation?
Yes
No
Transportation details
Would you be interested in being paired with a mentor if available?
Yes
No
If yes, please select areas of interest
School to career (navigating college/choosing a career)
Finding a job
Entrepreneurship
Navigating social services or other resources
Budget/financial stability/saving for a dream purchase
Health and well-being (nutrition/fitness/health/yoga/meditation)
Other
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Next
Funding Request
*
Housing/Utilities
Education
Food Security
Mental Health
Medical Health
Transportation
Other
Request Related to
Medical Crisis
Non-Medical Crisis
Education
Other
Requested Amount
*
Date Needed
*
-
Month
-
Day
Year
Please share details on the expenses that make up this amount
*
Include what each bill is, how much and how past due the bill is. This total should equal the total amount requested.
Urgent
Yes
No
Are you currently facing eviction?
If this is a housing request, what is the name and contact info of the apartment/landlord and the name(s) on lease?
Landlord name, contact info and name on the lease
Reason for Request
*
Please list all other sources of funding you have requested, the amount requested and the status. Enter N/A if this does not apply to you.
*
Tell us about all other sources of funding requested.
What will you do if you do not receive funding from Step Onward?
Tell us about the plan you are actively pursuing to obtain your own sustainability
Anything else you would like us to know?
Please read and accept by adding a check mark next to each statement.
*
Please upload any necessary related documents. For example, your lease if you are applying for housing assistance or your electric bill if you are requesting utility assistance. If you are facing eviction, please upload your notice to vacate.
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