Grants for Kids Form Please enable JavaScript in your browser to complete this form.Applicant's Name *FirstLastApplicant's Email Address *Applicant's phone number *Applicant's Relationship to Youth *SelfBio ParentKinship PlacementFoster ParentCase WorkerCASAYouth Support ServicesOtherIf you answered other, please explain:Please provide the name of the town where the youth is currently placed: *Is the requested item or event shared with more than one youth with an open dependency case in the same placement? *YesYesNoIf you answered yes, please enter the additional names, ages, genders, case workers, the court the cases originate from, and date of dependency for each youth in the below field:Youth's Name (First Name, Last Initial) *Youth's Age *Youth's Gender *Total Dollar Amount Requested *Date By Which Needed *Please allow up to three weeks for your grant request to be processed. If the "Date By Which Needed" falls within the next three weeks, please explain the urgency of this needDescription of item (including a direct webpage link to the item pasted into the box below) or service requested: * How does this item or service benefit the child? Grants for Kids needs to clearly understand the reason for the request before a grant can be approved *Recipient's name on the shipped item or check: *FirstLastShip items or mail check to: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeRecipient's phone number *Case Worker's Name *Case Worker's Email *What court does the youth's case originate from? *Submit
