Household Information
In the next 7 boxes, list the name, age, birthdate, gender, and race of each member in the household, including the parent(s). *Please enter one person per box.* If there are more than 7 people in your household, please use the last box to fill out the information for all remaining members.
Program Information
The next 3 boxes will ask for information regarding the program(s) you are requesting assistance for. Please note that a maximum of three (3) grants are awarded per organization/program per year. Due to funding, we will only assist up to three (3) children per program up to $200 per child per year. For each program, we will need:
1.) Name(s) of child/children attending- Ages 5-15 eligible
2.) Name, date, and total cost of the program
3.) Name of organization to which the check should be endorsed.
*We do not endorse checks to parents or individuals.*
Employer and Salary Information
Please fill out all questions entirely. Incomplete applications will be denied.
1.) Copy of Original birth certificates for all children for whom you are requesting assistance. If you have applied for a grant for a child previously, we still require that you send an e-copy for our files. We apologize for the inconvenience.