Georgia Kinship Project Inc. Resource Application

Georgia Kinship Project Inc. Resource Application

NOTE: This application is for relative caregivers ONLY! A relative caregiver is a parent either temporarily or permanently caring for a relative child. Relative caregivers may include: Grandparents, Aunts/Uncles, Cousins, Siblings, Step Parents, etc.
Primary Caregiver Name:

First NameLast Name
Secondary Caregiver Name

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian's Phone Number:

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Guardian's Email Address:
Secondary Email Address
example@example.com
Caregiver Financial Information

Please complete this section in its entirety.
Primary Caregiver's Employer
If unemployed, please indicate in the answer section.
Secondary Caregiver's Employer
If unemployed, please indicate in the answer section.
Primary Caregiver's Salary
Please indicate by annual or net monthly wage.
Secondary Caregiver's Salary
Please indicate by annual or net monthly wage.
Civil Status
What is your residential status?
How much is your rent or mortgage?
Are you in need of housing assistance? If so, please describe you needs below.
Details of residential needs.
Are the children eligible for free or reduced lunch?
Does the primary caregiver have health insurance? If not, do you need assistance obtaining health insurance?
Do the children have healthcare coverage/ insurance? If not, do you need assistance obtaining coverage?
Are you receiving any financial assistance (i.e. TANF, SNAP, Medicaid, Public Housing, etc.)? Please describe which services you are receiving.
Are you receiving child support?
Does the child’s biological parents reside (one or both) with the kin caregiver?

Other
Does the child/children's biological parents provide any financial assistance?
Child Information

Please describe each child's name, age, and needs.
Relationship to Child/Children:
How many relative children reside in the home?
Don't include your biological children.
Child #1 Full Name:
Child Age
Child's Date of Birth

MonthDayYear
Date
Child Gender

Other
Child Race/ Ethnicity

Other
Description of Multiple Races
Is this child in foster care?
Which County? If not in Georgia, which sending state?
Is this a temporary placement?
Child #2 Name:
Child Age:
Child's Date of Birth

MonthDayYear
Date
Child Gender

Other
Child Race/ Ethnicity

Other
Description of Multiple Races
Is this child in foster care?
Which County? If not in Georgia, which sending state?
Is this a temporary placement?
Child #3 Name:
Child Age:
Child's Date of Birth

MonthDayYear
Date
Child Gender

Other
Child Race/ Ethnicity

Other
Description of Multiple Races
Is this child in foster care?
Which County? If not in Georgia, which sending state?
Is this a temporary placement?
Child #4 Name:
Child Age:
Child's Date of Birth

MonthDayYear
Date
Child Gender

Other
Child Race/ Ethnicity

Other
Description of Multiple Races
Is this child in foster care?
Which County? If not in Georgia, which sending state?
Is this a temporary placement?
Child #5 Name:
Child Age:
Child's Date of Birth

MonthDayYear
Date
Child Gender

Other
Child Race/ Ethnicity

Other
Description of Multiple Races
Is this child in foster care?
Which County? If not in Georgia, which sending state?
Is this a temporary placement?
Case and Legal Status

Please indicate the services requested and if there is DFCS involvement, please indicate by acknowledging the case manager and the county where there is a DFCS case.
Is this a formal or informal kinship placement?
DFCS Case Manager Name

First NameLast Name
DFCS Case Manager Phone Number

Area CodePhone Number
DFCS Case Manager Email Address
example@example.com
Kinship Navigator/ Referrer Name

First NameLast Name
Email
example@example.com
If DFCS is involved, which county oversees the case?
Which county do you reside in?
Which DFCS Region is this case in?
Referral Needs
Please describe the child/ family needs. Please provide as much detail as possible.
If requesting clothing, would you like for it to be shipped or are you able to drive to Atlanta to shop and pick up?
Do you understand that if you are picking up, the children must stay at home due to COVID restrictions? This applies ONLY to clothing shopping and not furniture or other pick-ups.
Please select the items you need from the Outreach Closet. Select all that apply.

Other
The Georgia Kinship Project Outreach Closet is located in Warner Robins, GA. Are you able to pick up from this location?
Where did you learn about Georgia Kinship Project?
Should be Empty:

Georgia Kinship Project Inc. Resource Application

Caregiver Financial Information

Child Information

Case and Legal Status