2022 Friends of Children Funding Request

Date

Guardian ad Litem's Name*

First NameLast Name

Email*

example@example.com

Name of your CAM (Child Advocacy Manager). This person is a Guardian ad Litem Office employee who oversees a group of volunteers.*

GAL Phone number*

Area CodePhone Number

Total amount of funding requested. *

Please note: Requests over $300 per child will require full vote of the Board of Directors.

ALL REQUESTS MUST BE APPROVED BEFORE ANY PURCHASES ARE MADE.

Name of first child. Other children can be listed below*

First NameLast Name

Age/Gender*

Funding requested for this child*

Name of second child

First NameLast Name

Age/Gender

Funding requested for this child

Name of third child

First NameLast Name

Age/Gender

Funding requested for this child

Name of fourth child

First NameLast Name

Age/Gender

Funding requested for this child

Length of time in care*

Type of care*

Please indicate the city, state or county where the child is located*

What is needed for the child or children*

Describe the reason you are requesting that Friends of Children fund this need.*

What type of financial assistance is the caregiver currently receiving? *

Additional Comment:

Once your funding request is approved, Friends of Children can send items directly to caregivers, or we can send you a check upfront to make the necessary purchases. We do not send money up front to caregivers. Receipts are required for all purchases made. If you or the caregiver purchase the items upfront, we will reimburse for the approved amount once receipts are received.

Person receiving the check or receiving delivery of items ordered.*

First NameLast Name

Address for the check or where we can send items ordered. *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone number of person receiving check or delivery of item ordered. *

Type a question

You may attached a file here for items to order:

By clicking the submit button below you agree to the following:

I understand by accepting Friends' funds, I am responsible to provide Friends with receipts for the merchandise purchased and to return any excess funds.

Original receipts should be mailed to:

Friends of Children of Brevard
P.O. Box 360915
Melbourne, FL 32936

Phone: 321-247-9717

Your cooperation in submitting these original receipts within 10 days of purchase is appreciated, but must be submitted within 30 days.

Funds may only be used for the purpose intended.

If you have any questions or need to edit, please email: mail@FriendsofChildrenofBrevard.org.

Friends of Children Funding Request Form