3D CHILDREN'S SOCIETY - STUDENT FUNDING REQUEST FORM
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Website:  https://www.3dchildrenssociety.ca/
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3D FUNDING CRITERIA

Please read carefully and complete the form in full.

Background Information: Funds are generated through local and corporate sponsorships, which is about 80% of the total money raised. The remaining funds are raised through student participation and the silent auction at the annual 3D Children's Society Ball Hockey and Soccer Tournament when we have the three school district communities come together and raise awareness and have kids supporting kids.

Eligibility Requirements: Nominees must be a student in pre-kindergarten to grade 12 from one of the three school districts in and around the Grande Prairie area. The student must be currently receiving medical treatment that is deemed by the nominating teacher/administrator as being serious or life threatening. In the past we have had students with severe diabetes, organ transplants, cancer, osteogenesis imperfecta, Omenn’s Syndrome, and many others. 

Funds: Students who are currently receiving treatment will receive $3000 (funds permitting) in pre-paid gift cards plus a special gift. Students who are in remission, but are still in need of regular checkups, will receive $500 in funds at the discretion of the nominating teacher/administrator. These amounts can be subject to change depending on the funds available at the time of the request submission. 

Funding Submissions: The teacher/administrator must complete the Google Form entirely to apply for student funding. 

Funding Use: Parents/Guardians will be required to keep receipts of items purchased with gift cards and must provide them to the 3D Children’s Society upon request.

Please Note: The information on this form will be shared with the 3D Children's Society Funding Approval Committee.
Teacher/Administrator Nominator Name:   
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Teacher/Administrator Nominator Email Address:
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Student's (Nominee's) First & Last Name: *
School District: *
Student's School: *
Student's Grade: *
Parent/Guardian Name:  *
Parent/Guardian Phone Number: *
Brief Description of Student's Illness: *
Are you requesting that the 3D Children's Society help support with purchasing medical equipment? If so, please be very specific and indicate the equipment, cost, and where it can be purchased. 

If you have a document of the equipment needed, please email 3dchildrenssociety@gmail.com with the student's name and the document attached, and let us know here on this form to watch for the added submission.

If the student does not require medical equipment, please respond with "n/a".    N/A
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Are you requesting that the 3D Children's Society help support the costs endured by the family because of travel for medical treatment? 

If so, please indicate all that apply below as to what will be helpful for the family.

If cash cards are not required, please select "Cash Cards not Required".
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Required
Would the family like other cash cards that are not listed above? 

Please indicate specifics below; if not desired, please respond "no".
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As part of the 3D Children's Society funding request, will the student require or benefit from Equine or Aquatics Therapy through PARDS or Rise Above?
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Required
It has always been very important to us to provide a gift for the student. Please include what is on the student's wish list for a gift/gifts in the $250-$500 or less range. If and when possible, please try to include something that can be purchased in Grande Prairie and not something that has to be ordered.   
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If the nominee fits the 3D funding criteria and is approved for funds via the 3D Children's Society Funding Approval Committee, there is a presentation that accompanies the funding. Please select the type of presentation the family would be most comfortable with. *
Required
A copy of your responses will be emailed to the address you provided.
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