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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/Province *
Postal Code *