APPLY HERE! HiddenEnter EACH Child/Youth's Info *Required(Click on "Add Child" ) Youth Initials Date of Birth Case Number Actions Edit Delete There are no Children. Add Child Maximum number of children reached. Enter EACH Child/Youth's Info*(Use + button at right to add more rows) (Please use only 1 application per sibling group) Youth InitialsDate of BirthCase Number Please detail your communication with the OCS Special Needs Hotline 855-603-8637*(date of communication, who you spoke with and outcome of communication) or please note if Tribal custody only.Please specify what attempts were made to obtain funding from other sources prior to applying for this grant.*Name of Employer/Affiliation*You must be a CASA volunteer, GAL, OCS or Tribal caseworker in order to apply for a grant. CASA VolunteerGALTribeOCSCASA Program Staff MemberFIT CourtOtherRequester's Name* First Last Requester's Email* Requester's Phone*For camps, when direct pay is requested, provide business name and mailing address.Requestor's Mailing Address (for reimbursement)Amount Requested for each child*(Use + button at right to add more rows) Amount per child HiddenAmount requested per child/youth or total request for the family.*** Please note that funds must be encumbered by August 15. Any funds not spent or encumbered by that date will automatically lapse and the grant will close. HiddenCourt Case Numbers for all children (or # of children if this Event or Group project)* HiddenChild's Name* First Last HiddenChild's Age*Detailed description and cost estimate of need(s)*Is this a special request for an electronic device?* If so, acknowledgment of FACC’s Policy on Electronics is required. View Electronics Policy Form here No Yes A completed Electronic Policy Form is required for electronic devices (link is above). You may upload the completed Electronic Policy Form here.Max. file size: 50 MB.Acknowledgment of review of FACC grant policy*Type your initials to acknowledge that you've read and agree with FACC grant policy: View Grant Policy Date* MM slash DD slash YYYY CAPTCHAAcknowledgment of FACC’s Policy on ElectronicsMax. file size: 50 MB.PhoneThis field is for validation purposes and should be left unchanged. Δ
