Personal Application for Assistance

Application for Assistance

Enter your information below starting with the primary kinship caregiver. When you're done, click the submit button at the bottom of the form. If you're not sure about something, please email info@stepupparents.org
Before You Start

Gather These Documents First:

Proof that the children are in your care (such as custody documents, guardianship papers, or court orders)

Proof of income (if applicable) - this may include pay stubs, benefit statements, or tax returns

Information about everyone living in your household

Important: Have all your documents ready before beginning the application. If you leave the page during the process, you may lose your progress and need to start over.
Name*

First NameLast Name
Date of Birth*
(MM/DD/YYYY)
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Employer
Employer Name and Phone Number
If unemployed, date of last employment:
MM/DD/YYYY
Income Source and Amount
Spouse's Name

First NameLast Name
Spouse's Date of Birth*
(MM/DD/YYYY)
Spouse's Employer
Spouse's Employer and Phone Number
Spouse's Income Source and Amount
Household members*
First Name, Last Name, Date of Birth, and relationship to applicant
Background Information
How many children are in kinship care?*
List any additional resources and assistance not listed that you have received in the last 12 months.
Have the biological parents struggled with substance misuse?*

YesNo
Please tell us about how the applicant came to be a kinship caregiver. Please include information regarding the biological parents involvement with substance use disorder.*
Please explain the current situation and the reason for the request.*
Request for Assistance

Please include contact info, account number, and all details to make direct payment.
Kind of assistance*
Amount of funds requested (up to $500)*
Payee Info
Requested Documents
Proof of Income (if applicable)*

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TANF, social security, job income, or foster/slash adoption payments Cancelof
Guardianship Document*

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You must submit guardian kinship documents for children in your care Cancelof
Secondary Income Documentation (if applicable)

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Cancelof
Invoice/Bill (if applicable)

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Cancelof
Additional Documents

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Cancelof
Additional Documents

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Cancelof
Submission Status
Should be Empty:

Application for Assistance

Background Information

Request for Assistance

Requested Documents