Milton Foster Children's Fund Application for Funding - CASA of the ...

Milton FosterChildren’s FundApplication for FundingPLEASE READ BEFORE COMPLETING APPLICATIONThe Milton Foster Children’s Fund (MFCF) is dedicated to helping foster children develop the resiliency necessaryto become successful members of our community, allowing them to build a path that will lead them to a successfultransition into adulthood. In reviewing applications for funds, highest priority will be given to requests for essentialitems that will add to their resiliency. The following may be helpful as you determine if your needs are consistentwith the MFCF mission:• The child that funding is being requested for must be under the jurisdiction of the 4 th Judicial District .• MFCF cannot reimburse for expenses.• MFCF cannot fund ongoing activities or repeated requests. We can fund initial costs such as the first fewclasses/sessions, uniforms, instruments and enrollment fees.• Checks must be written out to the vendor/service provider. The checks will be mailed to the child’scaregiver so please be sure to include that mailing information.• MFCF requests that other funding options be exhausted first. We ask that this information be includedbelow.• The MFCF Allocations Sub-Committee meets the second Tuesday of each month. Applications are due thelast day of the month prior to the meeting. You will be notified of the sub-committee’s decision via mail.• MFCF requests that receipts be returned when you utilize awarded funds. This is necessary in order todemonstrate accounting integrity.• Often, we have questions once we receive the request for funding. Please respond promptly to our calls sowe may process the application and respond in a timely manner.• MFCF requires a thank you note from the benefiting child whenever possible. This is a life lesson for thembut also is helpful when seeking grants and donations. Any thank you notes shared are anonymous and allindentifying information blacked out.

APPLICATIONChild’s Name: __________________________ Race: __________________Name of person making this request: __________________________________________Today’s Date: _________________Relationship to Child: __________Requestor’s Phone Number and Email: _______________________________________________________________Child’s age: ________________________Approximate length of time in out-of-home placement: ____________Name of Foster Family or Group Home: ______________________________________________________________Foster Family or Group Home Address: ______________________________________________________________________________________________________________ Phone Number: __________________________________Child’s Caseworker: _________________________________ Email address: _______________________________Agency and phone number: ________________________________________________________________________Amount of request ($): ___________________Has this child applied for and/or received funds from MFCF previously? (circle one) Yes NoIf yes, details: ___________________________________________________________________________________Please give a description of the item(s) / services being requested: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What funding resources have you already investigated, and the results:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Are you asking for full funding of this request or will we be participating in the funding with another agency orindividual? Please give details: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please note:• Checks will be mailed to the caregiver. A copy of the award letter will be mailed to the personwho is making the request.• Requestor will be responsible for ensuring all funds are used only for the purpose stated in thisapplication and that the MFCF committee will receive a receipt for that purchase.• Checks cannot be made out to individuals and will only be made payable to the vendor who isproviding the service.

Name of vendor providing the service: ______________________________________________________________Address of Caregiver: ____________________________________________________________________________Special Mailing instructions: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________By signing below, I acknowledge that:1. I will ensure a receipt for goods/services purchased is provided to the MFCF committee.2. I will ensure any unused funds will be returned to the MFCF committee within 30 days of receipt.3. I will ensure the child to send a Thank You note that can be used anonymously for grant writing and reportingpurposes. This will allow us to assist more children in the future!4. The Foster Child is placed through El Paso or Teller County._________________________________________Signature________________________DatePLEASE RETURN THIS APPLICATION TO:Milton Foster Children’s FundCASA of the Pikes Peak Region, Inc.701 S. Cascade Ave, Colorado Springs, CO 80903Or Fax to: (719) 667-1818The Milton Foster Children’s Fund Allocations Committee meets the second Tuesdayof each month. Requests must be received by the first day of the month to be considered that month.In case of need for emergency assistance, you may contact: Michelle Geng at (719) 213-7795.Committee Decision Date: _________________________ Decision: Granted / RejectedReason for rejection: ______________________________________________________________________________Level of funding: $________________________________________________________________________________Committee Member Signature: ______________________________________________________________________