Consumer Advocacy Council of DeKalb County Request for Funds 2025

Consumer Advocacy Council of DeKalb County Request for Funds

The purpose of the CACDC is to provide one-time financial assistance to individuals living in DeKalb County, IL with chronic and persistent mental health conditions. This assistance is intended to support the case manager, counselor, or provider in resolving a presenting concern while providing immediate stabilization. Applications submitted by individuals will not be reviewed.
Date of Application*

MonthDayYear
Date
Provider Name*

First NameLast Name
Provider Agency*
Provider Email*
example@example.com

PAUSE

Have you reviewed the CACDC Provider Resource before completing this request?

Upcoming Meetings & Due Dates

Submission Due Date	Meeting/Decision Date
January 1, 2026	January 6, 2026
January 15, 2026	January 19, 2026
Feburary 3, 2026	January 29, 2026
February 17, 2026	February 12, 2026
March 3, 2026	February 26, 2026
March 17, 2026	March 12, 2026

Household & Financial Composition
Please write in third person

"Client lives with their spouse." | "Client receives SSDI and income from job at Amazon."
Number of Adults in the Home*
Number of Minors in the Home*
Who is in the household (children, spouse, parent, etc.)? *
Who is contributing to the household income? *
If someone 18+, such as the client's child or spouse, is in the home and not contributing to the finances, please explain
List all household income sources (employment, child support, etc.) for ALL household members*
List all household non-earned income sources (SNAP, TANF, General Assistance, VA Benefits, etc.) for ALL household members*

Request
Please write in third person.

"Client is engaged in case management and counseling." | "Receiving rental assistance would allow the client to focus on mental health services."
Immediate crisis (ex: risk of homelessness, utility shut off, medical emergency)Urgent but not life threateningPreventative or stability-focused
List the specific item(s) this request is for*
If requesting multiple items, include a cost breakdown, ex: past due rent rent-$1,000, glasses-$20
What is the TOTAL dollar amount being requested?*
YesNoUnsure
How is the current need impacting the client's mental health? *
How would approval of this request impact their mental health, ability to engage in services, household stability, financial well-being, etc.?*
Specifically list the resources the individual has utilized/attempted to access to resolve this situation, including the outcomes.*
If funds from another entity could be leveraged for this request, please state that here.
Who is on the client's care team (specific to mental health and financial well-being)?*
How long has this individual been engaged in services?*
How is the client going to prevent this from becoming a recurring issue (ex: enrolled in budgeting, seeking full-time employment, found a roommate, etc.)?*
Are there any special circumstance the CACDC Advisory Committee should be aware of to aid them in making an informed decision (ex: shelter placement, dietary needs, etc.)?

Supporting Documentation & Information

All payments will be issued directly to the vendor (landlord, utility company, Amazon, etc.)
If requesting rent...
Landlord/Property Manager Name
Billing Address

Street Address (including unit number if applicable)

Make Check Payable To...

CityState / Province

Postal / Zip Code
Upload a copy of the rent ledger and lease clearly stating the balance owed and the client's name. Utilize this space to upload any other supporting documents.

Cancelof
If requesting utility...
Utility Company Name
Billing Address

Street Address (including unit number if applicable)

Make Check Payable To...

CityState / Province

Postal / Zip Code
Upload a copy of the utility bill clearly stating the balance owed and the client's name. Utilize this space to upload any other supporting documents.

Cancelof
If requesting vehicle assistance...
Vendor (loan company, mechanic shop, etc.
Billing Address

Street Address (including unit number if applicable)

Make Check Payable To...

CityState / Province

Postal / Zip Code
If requesting vehicle assistance proof of insurance and registration are required - upload here

Cancelof
Upload a copy of the bill and any other supporting documents

Cancelof
If requesting clothing, household essentials....

Items will be purchased directly from Amazon, Walmart, etc.
Include links to requested items (ensure the total price requested includes any shipping costs, taxes, etc.)
Please indicate if the items should be delivered to your office or the client's home.
If requesting something else....
Details about the request
Utilize this space to upload any other relevant documentation

Cancelof

Process & Overview
YesNoOther
Submission
- Applications must be submitted by a mental health provider, case manager, or counselor.
- Applications submitted by individuals will NOT be reviewed.
- The CACDC Advisory Committee reviews applications twice a month. Applications must be submitted at least three days before the CACDC Advisory Committee meeting to be reviewed.
- To submit additional documentation or to request a copy of this application, email CAP@fsadekalbcounty.org.
Approval
- Family Service Agency will notify the provider of the decision immediately following the CACDC Advisory Committee meeting.
- Funds are contingent upon timely response from the provider. Upon notification of approval, the provider has ten business days to provide all requested documentation and/or information.
- After ten days of inadequate response, the allocated funding for the client will be forfeited and a new request must be submitted to the Committee for review.
By signing this document, you attest that the information submitted is accurate to the best of your knowledge and that you have thoroughly read the submission and approval details.
Provider Signature

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Consumer Advocacy Council of DeKalb County Request for Funds

PAUSE

Client Demographics

Household & Financial Composition

Please write in third person

Request

Please write in third person.

Supporting Documentation & Information

If requesting rent...

If requesting utility...

If requesting vehicle assistance...

If requesting clothing, household essentials....

If requesting something else....

Process & Overview

Submission

Approval

By signing this document, you attest that the information submitted is accurate to the best of your knowledge and that you have thoroughly read the submission and approval details.