Language
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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.
Parent or Caregiver
Name
Parent / Caregiver 1 First Name
Parent / Caregiver 1 Last Name
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
Gender
Female
Male
Non-binary
Date of Birth
-
Month
-
Day
Year
Caregiver 1 Age
Caregiver 1 Age Group
Race and/or Ethnicity - Caregiver 1 (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
I am a single parent.
Yes
No
EMPLOYMENT
Current Employment Status
Currently employed
Unemployed
Actively seeking employment
Other
Current Employer
Current Occupation
Job title or what you currently do
How long have you been at your job?
Please Select
0-2 months
3 months - 1 year
1-2 years
3-5 years
6-10 years
10+ years
Average number of hours worked per week
Please Select
Less than 10
10-20
20-30
30-40
40+
I am unable to seek employment because my child requires 24/x7 care
Please Select
Yes
No
Parent or Caregiver 2
Name
Parent or Caregiver 2 First Name
Parent or Caregiver 2 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 - Caregiver 2 (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
EMPLOYMENT
Current Employment Status
Currently employed
Unemployed
Actively seeking employment
Other
Current Employer
Current Occupation
Job title or what you currently do
How long have you been at your job?
Please Select
0-2 months
3 months - 1 year
1-2 years
3-5 years
6-10 years
10+ years
Average number of hours worked per week
Please Select
Less than 10
10-20
20-30
30-40
40+
I am unable to seek employment because my child requires 24/x7 care
Please Select
Yes
No
EMPLOYMENT
REQUIRED FOR AGE 18 AND OLDER
Current Employment Status
Currently employed
Unemployed
Actively seeking employment
Other
Current Employer
Current Occupation
Job title or what you currently do
How long have you been at your job?
Please Select
0-2 months
3 months - 1 year
1-2 years
3-5 years
6-10 years
10+ years
Average number of hours worked per week
Please Select
0
Less than 10
10-20
20-30
30-40
40+
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PATIENT INFORMATION
Patients generally receiving care at a local hospital.
First Name
First name of patient
Last Name
Last name of patient
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Female
Male
Non-Binary
I am a dependent
Yes
No
Age Group
Age
Race and/or Ethnicity - Recipient (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
Declined
Other
# of adults in the home
*
# of your dependents under 18 in the home
*
OTHER HOUSEHOLD OCCUPANTS
PLEASE USE THIS SECTION TO DOCUMENT ALL PERSONS LIVING IN YOUR HOME, EXCLUDING THE PATIENT AND CAREGIVERS ALREADY IDENTIFIED ON THIS FORM.
PLEASE DO NOT INCLUDE PATIENTS, STUDENTS OR CAREGIVERS ALREADY IDENTIFIED IN THIS APPLICATION.
HOUSEHOLD INFORMATION
PLEASE ENTER THE COMBINED HOUSEHOLD INCOME AND EXPENSES THAT INCLUDES ALL HOUSEHOLD MEMBERS.
Please enter your total monthly income that includes all household members. Enter a 0 for any that do not apply.
*
Amount
Salary/Wages
SSI
Disability
Child Support
Food Stamps
Other Monthly Income
Please enter your total monthly expenses that includes all household members. Enter a 0 for any that do not apply.
*
Amount
Rent/Mortgage
Groceries
Utilities
Phone
TV/Internet
Car Payment
Car Ins
Child Care
Child Support
Credit Cards
Medical Ins
Medical Bills
Other Monthly Expenses
Total Monthly Income
Total Monthly Expenses
Annual Household Income
Please enter the total amount of income per year for your household
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How did you hear about us?
Referring Organization
*
Dell Children's Hospital
Texas Children's Hospital
Lifeworks
Presbyterian Children's Home
Champion Institute
Depelchin
Star of Hope
Communities in Schools
Other
Please provide the first and last name of your social worker or person(s) referring you to us.
*
First and Last Name of the person referring you.
Please provide the email address of your social worker or person(s) referring you to us.
*
example@example.com
History of or currently experiencing (please select all that apply)
Family Medical Crises
Homelessness or housing insecurity before age 18
Homelessness or housing insecurity after age 18
Currently experiencing homelessness
Food Insecurity
Domestic Violence
Juvenile Justice
Substance Abuse
Refugee
Trafficking
Foster Care
Other
Financial Support Systems (please select all that apply)
*
Employment
Government Assistance
Student Loans/Grants
Family/Friends
Other Non-profit Funding
None
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
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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FUNDING REQUEST
Please provide as much detail as possible to help our team make the best informed decision.
Request
*
Housing/Utilities
Education
Food Security
Mental Health
Medical Health
Transportation
Pet Food
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.
Reason for Request
*
If you have received emergency housing assistance from Step Onward in the past, please elaborate on what's changed since you last received assistance and the obstacles that have prevented you from achieving your goals.
Only required if you have received emergency housing assistance in the past
Urgent
Yes
No
Are you currently facing eviction?
Housing Information
Please complete this section if your request is related to housing. You may skip this section if your request is not related to housing.
If you are facing eviction, please provide some additional details - i.e. how much is needed to avoid eviction, if you have a court date scheduled etc.
What is the name of your apartment complex or your landlord's name?
Apartment or landlord name
What is the contact name and phone number for your apartment or landlord?
Contact name and phone number
What name(s) is on lease?
Name(s) on the lease
Education Information
Please complete this section if your request is related to education. You may skip this section if your request is not related to education.
I am receiving or have applied for the following education assistance (please check all that apply)
The maximum FAFSA amount available
Other student loans
A Pell or other grant
Other scholarships
My family is helping me cover some of my education and living exepenses
I am working or plan to work to help cover my education and living expenses
Other
Which school are you attending?
Additional Details
Please list all other sources of funding you have requested, the amount requested and the status. If none, please list other sources you plan to pursue. Please explain if you have not and don't plan to pursue other funding sources.
*
Tell us about any other sources of funding you have 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 bank statements for the last 2 months.
*
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Please upload any other 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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