Chosen Ones Foundation

What is it?

Chosen Ones Community Foundation reviews needs of children touched by the foster care system that may not be covered by monthly reimbursement, or may occur after placement before monthly reimbursement begins The Chosen Ones Community Foundation works with donors and resources to get these needs covered for foster children, kinship children/families and FBSS open cases.

All applications must be filled out by a caseworker or permanency worker or similar. Individual families may not submit applications.

If a family you know is in need of support for an out-of-pocket expense for a child who has been touched by the DFPS system, consider submitting an application for a one-time financial gift. Please follow instructions below.

All applications will be reviewed and a response will be submitted within 72 hours.

Caseworkers please be advised that distributions are limited to 1 per family. Checks are made out directly to the business, NO individuals. Once the request is approved, checks can be picked up by the caseworker or family during our regular business hours.

Questions? Email Wilma May placement@chosenones.org

Chosen Ones Community Foundation Application

SECTION ONE: Caseworker/Permanency Specialist/Kinship Worker INFO

Name

Agency Represented Name

Address Line 1

City

State

Zip Code

Confirm Email

Phone

SECTION TWO: RESOURCE FAMILY INFORMATION

What should we know about the resource family? Any special or extenuating circumstances that should be considered when reviewing their need?

Name of Child in Care: First, Last Initial

Child Age:

Child Gender:

Name of Agency, DFPS Division, Region etc.:

Caseworker Name:

Caseworker Phone Number:

Caseworker Email:

SECTION THREE

Specific need of child or family, Please provide as much detail as possible:

Estimated cost of need:

Have you identified a Provider for the need (Ex, store, doctor, repair shop, daycare etc.)(required)

YES NO

If yes, please include name of Provider:

Phone number:

Email or Provider (if applicable):

Is there anything additional we should know about this request?

SECTION FIVE: ACKNOWLEDGMENT

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application.

Signature of Applicant (type your full name)

By typing your name in the space above, you are electronically signing Chosen Ones Foundation application.

Signature Date (YYYY-MM-DD)