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Funds Request Form

Reminders before completing a funds request:

  • Make sure the vendor information is current and accurate.  This is your responsibility. 
  • You are responsible for making sure the monies are used as described.
  • Allow a minimum of 7 days between the date request is submitted and the date approval is needed.
  • MOST funded requests will require a completed evaluation.
First Name
Last Name
GAL Supervisor
County of Court Case
Kinship or Foster Placement
If request includes multiple children, please include their details in additional information field at bottom.
First Name
Last Name
Child Gender
Will DSS pay for this item/activity?
Country
Address Line 1
Address Line 2
City
State
Postal Code