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Grant Application

Youth Initials (or "group" if this is an event)*
Case Numbers for all children (or # of children if this is an event)*
Child's Initials*
First Last
Child's Age*
Requester's Name*
First Last
Relationship to child(ren)*
Please indicate your program affiliation:*
Requester's Email*
Requester's Phone
Requestor's Mailing Address (for reimbursement)
For camps, or where direct payment is requested, provide business name and mailing address:
Amount Requested*
Travel Amount
Description of Need*
Is this request for an electronic device?*
- No
- Yes
Describe the therapeutic, educational, or OCS approved family contact needs of the child and how the device is necessary to fulfill those needs.
Describe the means by which OCS and/or the school district have taken care of the needs of this child and explain why those methods are not sufficient.
What recommendations have been received from a medical or educational professional regarding this need?
If the cost of the recommended device is expected to exceed $250, please explain why the device you are requesting is necessary to fulfill the child’s needs.
A completed Family Placement Agreement is required for electronic devices. See FACC's main grants page for a link to the form. You may upload the completed Family Placement Agreement here.
Applicants must request funding from OCS for this need prior to applying for a grant. Please provide the OCS case worker's name, date of contact, and her/his response to your request:*
Funding Attempts*
What other funding sources have you explored?
- Foster care payments
- Community Resources
- None
Additional Information
Date*
Date Format: MM slash DD slash YYYY
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Phone
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Grant Application

Friends of Alaska's Children in Care

PO Box 242484, Anchorage, AK 99524-2484

info@friendsofalaskascc.org

Gayle W – CASA Volunteer

Grant Application

Friends of Alaska's Children in Care

PO Box 242484, Anchorage, AK 99524-2484

info@friendsofalaskascc.org

Follow FACC

Gayle W – CASA Volunteer