Jefferson County Foster Children's Fund Scholarship Request Form

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Examples of things a Scholarship from JCFCF can be applied to: Start-up funds for Independent Living, Sports Camps, Summer Camps, Prom/Homecoming, Extracurricular Activities associated with school, Graduation expenses, college needs, medical devices not covered by Medicare, etc. This is not an all inclusive list, but will give you an idea of how we might be able to help.

Scholarships will be awarded based on available funds and Board approval. The Board meets monthly. If the funds are needed sooner, please indicate this on the form below. If you have an questions, feel free to reach out to a Board member in person, by phone, or by email.

Child’s name *

Child’s date of birth *

YYYY

Child's Gender *

Placement Name *

Placement Phone Number *

Placement Address *

Agency *

Case Manager *

Case Manager Phone Number *

What is the request for? *

Dollar Amount Needed *

Please describe in detail how the funds will be used. *

Date Funds are Needed by *

YYYY

Has the child's Kid Account been reviewed? Please explain *

Have you contacted ChaFee for funding? Please explain *

Individual Submitting Scholarship *

How can the funds be paid straight to provider? (online? Mail check?) Please provide web address or address to mail to information *

Submit

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