JA & Summit Family Assistance Request
If your family is experiencing hardship, please complete this form so that our Community Engagement Coordinator, Tiffany Blakley, can review the needs and connect with you about potential assistance options. Your information and request is kept confidential (aside from Tiffany). If you prefer to speak to Tiffany directly, please call 720-798-1518.

*Please note: We cannot guarantee assistance. We will do whatever possible to provide and/or connect your family with resources that can assist you.*
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Full Name *
Phone number *
Email address *
# of children living in the home *
School(s) and grade level(s) *
# of adults living in the home *
County of residence *
Please describe the current hardship/situation. *
What type of assistance are you looking for? (Check all that apply) *
Required
Please provide detailed information for the assistance requested (For example: bill pay: bill type, amount owed, account number, etc; transportation: bus pass needed?, car repairs needed?, etc.). Ultimately- please indicate the AMOUNTS needed for the various needs requested. *
Have you contacted other agencies for assistance (such as 411, Salvation Army, etc)?  *
Are you ok with us informing the school admin and/or counselor about your hardship, so that they can also assist however possible?  *
Is there anything else you would like us to know?
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