Empower Funding Request Any foster youth age 14 to 24 in out-of-home care (foster care, relative care, non-relative care, and group homes) or EFC/PESS residing in or managed from Orange, Osceola, or Seminole County is eligible to receive funds. Funding may be approved in the following categories: career, education, housing, parenting, and personal & social development; school-based activities and transportation. Approvals are dependent on the availability of funding. FFC reserves the right to modify services and policies, at any time. As a policy, we do not reimburse. Processing usually takes 10-15 business days. Submitter Name* First Last Submitter Phone Number*Submitter Email* Relation to the youth*Self (Youth over 18)CaregiverIL Specialist/TSSCase ManagerGALSelf (Youth under 18)OtherIf other, please specify.*Youth InformationYouth Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Is the youth 18 or older?*YesNoGender*FemaleMaleDoes the youth have children?*YesNoEthnicity*African-AmericanAsian-AmericanCaucasianHispanic-LatinoMulti-EthnicParental Rights Terminated*YesNoNot SurePlacement*Foster HomeGroup HomeRelative (Not Bio Parent)Non-Relative ParentOtherGroup Home Name*School Currently Attending*Student ID #Is the youth case closed?*YesNoIs the case likely to close or be reunified in the next two months?*YesNoNot SureIs this case OTI or ICPC?*OTIICPCNeitherYouth will send a "thank you" card/letter within 2 weeks of receiving services.* Yes Activity InformationEMPOWER Success Funds*CareerEducationHousingParentingPersonal and Social DevelopmentSchool-based activitiesTransportationCelebrationCareer*Interview attireUniformsEquipmentFingerprintingDrug testingProfessional development resources i.e. books, certifications, licensures, and professional trainingOtherEducation*UniformTextbooksLaptop/ComputerSchool SuppliesApplication/Testing feesCollege toursEducational/technical trainingCertifications and licensuresOtherHousing*Application feesApartment holding fees & depositsUtility depositsShelter feesMoving assistanceHousewarming basketsFurnitureOtherParenting*Professional parenting classesChildcare application & deposit feesParent-child bonding activitiesOtherPersonal and Social Development*Athletic and art leaguesAthletic and art classes/lessonsUniformsEquipment and suppliesCultural experiencesLife skills development trainingCertificationsOtherSchool-based activities*Field tripsExtra-curricular clubsSchool-based sportsSchool-based eventsSenior promGraduation packagesOtherTransportation*Driving lessonsDriver’s licenseTags & titlesCar insurance depositsCar repairsCar purchasesBikeBus passesLYFT/UBER gift card/creditsOtherIf other, please describe*Cost of Activity*Is the youth registered for this activity?*YesNoN/AActivity Provider Name*Activity Provider Phone*Activity Provider Email* Activity Provider Website Activity Provider Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What birthday is the child/youth celebrating?*16th or younger17th or olderIs a cake being requested?*YesNoDoes the youth have any food allergies?*YesNoPlease provide the name that you would like to be on the cake for the youth.If yes, please explain what type of food allergy that the youth has.*Type of Cake*VanillaChocolateRed VelvetCookie N' CreamType of Icing*VanillaChocolatePlease provide an idea of how the youth would like the cake decorated with a theme or favorite character, and we will try our best to accommodate.*Has the child mentioned a certain vision or desire for their celebration?*Number of people celebrating*2-910-19Is a gift being requested?*YesNoYouth's Favorite Color*Please describe the youth's interests and why a cake and/or gift cannot be provided by the caregiver.*Date to pick-up cake and/or gift from the Foundation office:* Date Format: MM slash DD slash YYYY Please attach all documents relevant to this request.Please describe the current need, including how this activity would benefit the youth*Caregiver InformationCaregiver Name* First Last Caregiver Phone*Caregiver Email* Address where youth resides:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code County*OrangeOsceolaSeminoleCase Manager/IL Specialist Information/TSSCase Manager Name* First Last Case Manager Phone*Case Manager Email* Case Management Agency*Case Management County*Supervisor Name First Last Supervisor PhoneSupervisor Email
