2025 Boost Request Assistance Form

2025 Boost Request Assistance Form
NOTE: Due to a high volume of requests, it may take a few days before your items are ordered. Please be patient with us. It helps if you fill out the form carefully and completely.

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. Questions? Please contact us here.
Type of Placement*

Kinship (hover for definition)Community/Non-Kin (BOOST is not accepting requests for Non-Kin placements at this time). Please contact Arizona Friends of Foster Care, The Foster Alliance or José's closet for resources.Reunification (BOOST will consider assisting a family reunifying on a case by case basis)
Boost a Foster Family does not take requests for the following: rent/mortgage assistance, utilities, car repairs, appliances, home remodels, cribs, high chairs, strollers, swings, bicycles, clothing, shoes, diapers, formula, tables, chairs, furniture, and computers. Please limit your request to items required for Arizona State Licensure.

Boost a Foster Family does not take requests directly from families. If you are a foster parent needing assistance, please contact your caseworker or licensing worker.
I understand the limitations described above*
Initial Here
Referring Worker's Name *

First NameLast Name
I work for
Select Agency Office*
If not listed above please list Agency name and address
Leave blank if the address in the drop down list above is correctly listed.
Referring Worker's Cell Phone *

Area CodePhone Number
Referring Worker's E-mail*
Family Information

Please provide the following data on the family in need of assistance. In order to expedite assistance, Boost is requesting identifying information. You must obtain proper permission/releases.
I have gained permission to share identifying information with Boost a Foster Family **
Name of Primary Contact in the Family*

First NameLast Name
Is this Primary Contact English Speaking?*

YesNo
If No, what language do they speak?*
Family SHIPPING Address - *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is MAILING address different from SHIPPING address*

YESNO
Family MAILING Address - *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AZ County of Residence*
Family Primary Contact email *
DO NOT PUT WORKER's EMAIL (if family does not have email state "none")
Family Primary Contact phone number*

Area CodePhone Number
If Kinship, Nature of Relationship*
What best describes the family's situation?*
If family is licensed, explain why they are unable to use their reimbursement to cover cost of this request.*
Is this family Low-Income (less than twice the federal poverty threshold) Hover for definition*

YesNo

List ALL Adults in the Home including adult children (more than 5 adults, please list data in Additional Info)*

	Race/Ethnicity
Adult 1
Adult 2
Adult 3
Adult 4
Adult 5

Number of Adults over age 60*
Number of Adults that are Veterans*
Total Number of Children in the Home (include those already placed and those awaiting placement)*
Birth, foster, adoptive and others
Of the total children, how many are Foster Children*
Include those waiting to be placed here and below and explain in Additional Info section

List ALL Children under 18 in the Home include those ALREADY PLACED and those AWAITING PLACEMENT. (more than 8 children, please list data in Additional Info)**

	Race/Ethnicity	Relationship	Age	Gender
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8

Help Needed:

You must fill in all requested information or your submission will not be accepted.
Where do you want items delivered?
Car Seats

NOTE: Boost will provide one car seat for each foster child in the home if the family does not already have a functioning car seat for that child. Do not request extra seats for second cars or additional caregivers. If more than three children need car seats add the info in additional car seat info section.
Does family need a car seat (if yes, complete the Car Seat Info table below)*

YESNO
How many car seats needed
Boost will provide one per foster child. No extra seats

Additional Car Seat info
Bunk Beds & Toddler Beds

Boost will only provide bunk bed frames or toddler bed frames unless there are no other resources for mattresses in the family's community.
One bunk bed accommodates two children. One child must be over age 6 - children under age 6 are not allowed on the top bunk. Boost will not provide a bunk bed for a single child. Toddler beds will not be provided for children over age 4.
Does family need a bunk bed or toddler bed?*

YESNO
How many bunk beds needed
One bunk bed accommodates two children.One child must be over age 6 years.
How many toddler beds needed*
For chldren under age 4 years.

Additional info for Bedding requests.
Weapon Cases

OLR requires firearms tamper-proof, locked storage container made of unbreakable material; and other weapons (bows, air/bb guns, hunting knives) be rendered inoperable stored in a locked area.
Does family have weapons that need to be secured*

YESNO
Total number of weapons that are not yet secured
include guns, swords, bows, etc.

Additional info for weapons.
General Safety Items

Please put any specific notes in the comments section for each item

Item List:

	Qty	Comments
First Aid Kit
Tub Treads/Shower Mat
2A:10B:C Fire Extinguisher
Smoke Alarm (one per bedroom and each main living space)
CO Alarm (only needed in homes with gas appliances or wood burning devices - 1 per floor)
Lockable Box for Medications (note size in comments)
Lockable Bin for Toxins (large plastic bins, locks included)
Magnetic Cabinet Locks designed for children under age 6 (note number of cabinet doors in QTY)
Exterior cabinet locks for children over age 6 (note number of cabinets in QTY)
Refrigerator bags for medicine
Dog Rabies Vaccinations -Dogs over 6mo. old
Ring Buoy for Pool (pool must be over 6 ft deep)
Shepherd's Hook for Pool (pool must be over 6 ft deep)
Well Water Test
Plastic Drawer Unit
Outlet Covers (package of 20)

Other Items/Help Needed
CPR/First Aid & Doctor's Physical Requests

REFERRING WORKER: If requesting CPR/First Aid or Physicals, please alert that family that we will email the family within 5 days with instructions on moving forward.

CPR/First Aid & Doctor's Physicals

	QTY	Comments
Doctor's Physicals
CPR/First Aid Classes

Verify for CPR & Physicals Requests

By clicking here, I verify I have contacted the family to alert them that we will be contacting them directly.
Additional Information
Anything that will help Boost fulfill your request.
Household Repair & Pool Fence Requests

To request home repairs, please complete the Home Repair Form. NOTE: two estimates/bids must be submitted with this form.

For Pool Fences please submit a specific Pool Fence Request form.
Newsletter

Receive Boost Newsletters (usually sent quarterly)
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 30 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:

	Child's Age	Child's Weight	Child's Height	Gender
Car Seat 1
Car Seat 2
Car Seat 3

	Bunk or Toddler	Need Bedding?	Bedding preference (color, interests)	Child's Ages	Child's Genders
Bed 1
Bed 2
Bed 3
Bed 4

	Weapon type	Dimensions (Length, width, depth at widest point)	Need Trigger locks
Weapon 1
Weapon 2
Weapon 3
Weapon 4
Weapon 5
Weapon 6

2025 Boost Request Assistance Form

Family Information

Car Seats

Bunk Beds & Toddler Beds

Weapon Cases

General Safety Items