Grant Application for Social Workers
Child's first name & initial of last name
How long known to Agency? If in placement, provider and when?
Client's interest/future plans:
Has the child received a BFK grant before?
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
Current source(s) of income of child/family
Other funding source(s) explored
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
(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
Should be Empty: