Expect a miracle assistance application

Please be sure to apply via desktop/laptop, not a mobile device.

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.

REQUIRED SUPPORTING DOCUMENTATION

All documentation listed is REQUIRED. If anything is missing, your application will be rejected. Please note the two upload boxes according to your file type.

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• Supported image file types: jpeg, pmg, jpg

• Supported document file types: pdf, doc, docx, ppt, pptx, xls, xlsx, odp, odt, epub

• Be sure the text below the upload form updates with your file name or your file did not upload.

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.

2.) Original and most recent pay stub, showing at least 20 hours of work per week (direct deposit pay stubs are acceptable)

3.) A short statement indicating you are a single working parent. Please also briefly tell us about your family and need for assistance.

Thanks for submitting! Remember: There is a 60-day processing period. Incomplete applications will be denied.