Funds Request Form : For Guardians : Cape Fear Guardian ad Litem Association

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.
Camp and Tutoring fund requests will require a completed evaluation.

Date of Request (Required)

GAL Name

First Name *

Last Name *

GAL Email Address (Required)

GAL Phone Number (Required)

County of Court Case

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Kinship or Foster Placement

Child's First Name (Required)

If request includes multiple children, please include their details in additional information field at bottom.

Last 3 Digits Child Case Number (Required)

Child Age (Required)

Child Gender

Items(s)/Activity Requested (Required)

Will DSS pay for this item/activity?

How will this item/activity benefit this child? (Required)

Date of activity or date activity starts (Required)

Activity Completion date, if applicable

Funding Amount Requested (Required)

What Date Is Payment Required

Check Payable To (Required)

Attention (if applicable)

Full Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Additional Information (as needed)