Grant Application for Social Workers
Bucks for Kids is the LAST funding resort for Foster Kids needs when all other funding sources have been exhausted. Kindly provide as many details as possible.
Date
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Month
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Day
Year
Date Picker Icon
Worker's Name
*
First Name
Last Name
Child's first name & initial of last name
*
Town
*
Age
*
School Level
*
How long known to Agency? If in placement, provider and when?
Client's interest/future plans:
Check here if a parent is/was incarcerated.
Yes
Has the child received a Bucks for Kids grant before?
*
Yes
No
If YES, please list date, purpose and how this child benefited from the grant
Reason for Grant request
*
(If a camp request, please fill out camp info questions)
How will this Grant benefit the child?
*
Total cost of the item/service requested
*
Amount child/family can contribute
*
Amount requested
*
Current source(s) of income of child/family
*
Other funding source(s) explored. List specifically what other resources have been explored and their responses.
*
Include if they are "confirmed", "pending", or "rejected"
Make check payable to:
*
NOTE: Checks payable to anyone other than the service provider cannot be issued unless accompanied by a bona fide receipt.
Write a summary for the request: reason, benefit, agency's involvment. If a program is on going (camp, sports, gymnastics, karate) list specifically the number of sessions, classes, time period, etc.
*
CAMP INFORMATION
(fill out below section if applicable)
Weekly Camp Cost and number of Weeks
Type of Camp
(ex. community, special needs, day or night)
Camp goals for child
Submit Form
Should be Empty: