Financial Assistance Application
Hood County Children's Charity Fund
Hood County Children's Charity Fund provides for the immediate and emergency needs for the children in Hood County. For purposes of providing charitable assistance, an “Emergency Need” shall mean an unexpected, urgent, and necessary expense or circumstance that threatens or materially affects a child’s immediate health, safety, basic well-being, or ability to remain in a safe and stable living environment. The HCCCF Board of Directors is a volunteer board that individually evaluates the needs of every case brought forth and has the right to determine how the needs and outcomes aligns with our mission statement. All applications must be filled out completely in order for the Board to review the need. Turn time for response is 24 - 48 hours.
Name of Person Applying
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Total number of CHILDREN ages 18 and under living in the household:
Total number of ADULTS living in the household:
List all sources of household income including jobs, disability payments, child support, or other federally funded programs.
List Children's Name - Date of Birth - Relationship to person filling out form
List the Names - Date of Birth - and Occupation for each ADULT in the household.
Type of Assistance Needed
Emergency Housing / Rent Relief
Utility Bill Support
School Supplies / Backpack
Clothing & Footwear
Food Assistance
Medical / Perscription Support
Other
FINANCIAL ASSISTANCE - List all bills with amounts.
CLOTHING / SCHOOL SUPPLY ASSISTANCE - List CHILD's name with sizes and grade level.
REASON FOR ASSISTANCE REQUEST: Please describe the current hardship or event that led to this need. Provide detailed information that details the loss, effects from the loss, and what you have attempted to work through.
OTHER AGENCIES ASSISTING: Please list other community agencies that you have reached out to, what they are assisting to, and amounts given or pledged.
Upload a copy of your Drivers License, Government ID, or Passport.
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Upload proof of the children living at home. This could be a screenshot of their Skyward Account, Medicaid, or something that shows their name and address that matches person requesting assistance.
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Upload a copy of the bill or written documentation showing the amount due.
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Please sign this form stating that you agree for HCCCF to review your application, contact you for further questions, and reach out to other partner agencies you listed in this application. Upon receving a complete application, HCCCF will reach out to you within 24-48 hours.
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