2024 Household Repair Request Assistance Form

2024 Household Repair

Kinship Families Only

Estimates/Bids are required to submit this form.
At this time, BOOST a FOSTER FAMILY only accepts referrals for KINSHIP families experiencing financial hardship or who have other barriers prohibiting them from becoming licensed or taking placement. Questions? Please contact us here.

NOTE: The family must gather two quotes for the work needed and the quotes must be submitted with this application.

If you are the family filling out this form STOP RIGHT HERE and have your DCS or Agency Worker complete the form. If the family fills out this application, assistance will be denied.
INITIAL HERE to agree that this request is ONLY for safety measures required by the State of Arizona for placement of a child or for Foster Care Licensure.
Family Information

Please provide the following data on the family in need of assistance (all entries are required):
Family Name*

First NameLast Name
Family Email (best email for the family)
example@example.com
Family Phone Number*

Area CodePhone Number
Family Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence*
Does the family own the home? Proof of ownership may be required.*

YESNO
Additional Required Information
Total Number of Children in Home*
Birth children, adoptive children, foster children and informal placements
Number of Foster Children in Home*
only foster children
Number of Veterans in Home*
Number of Adults over 60 living in the home*
Nature of Kinship Relationship*
What best describes the family's situation?*
Is this family Low-Income (less than twice the federal poverty threshold)*

YesNo

List Each Household Member*

	Role	Race Ethnicity
Person 1
Person 2
Person 3
Person 4
Person 5
Person 6
Person 7
Person 8

Agency Information
I certify that I work for DCS or a foster care licensing agency in Arizona and that I am filling this out on the behalf of a needy Arizona family. I agree to vouch for the family's financial need.
Select Agency*
If not listed above, please type Agency Name and full address.
Licensing/DCS Worker Name*

First NameLast Name
Licensing/DCS Worker E-mail*
Licensing/DCS Worker Cell Phone Number*

Area CodePhone Number
I have gained permission to share identifying information with Boost a Foster Family*

VerbalEmailSigned Release of Information FormOther

Type of Repair Needed*

	Type	Explain what and where in home
Repair 1
Repair 2
Repair 3
Repair 4

*NOTE - for Yard requests you must explain why the family cannot do the work themselves in the box below.

For electrical or plumbing, vendors must be licensed and bonded.
Please explain the Kinship Family's situation and why they need assistance.*
Family must find vendors in their area to do the work and provide a minimum of two quotes/estimates for the work.

A representative from Boost a Foster Family will then contact the family to determine how much assistance can be provided.
ESTIMATE/QUOTE #1*

Browse Files

Cancelof
Total amount of Quote 1*
All costs including materials, labor and taxes
ESTIMATE/QUOTE #2*

Browse Files

Cancelof
Total amount of Quote 2*
All costs including materials, labor and taxes
Which quote does the family prefer and why?*
For requests over $500, how much can the family afford to pay?
Please include any other information, you think pertinent.
Please note: We commit to responding to this referral as soon as possible. Sometimes additional information is required in order to fulfill the order. If we do not receive the requested information within 90 days, this referral will expire.
Signing your name here confirms your acceptance of Boost a Foster Family Terms and Conditions *

Clear
Enter the message as it's shown*
You will receive an email confimation after clicking SUBMIT. If you do not receive the email within a few minuntes, please check this page to make sure all the required fields have been completed. Contact us if you have futher problems.
Should be Empty:

Family Information

Additional Required Information

Agency Information