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. Application Date* Date Format: MM slash DD slash YYYY 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 Youth Email*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*Grade*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 trainingOtherIf you have a tutor request please complete our Tutor form on the link below. For all other Education requests please continue with this form.Please copy and paste the following link: https://foundationforfosterchildren.org/funding-request-forms/new-tutoring-request-prek-college/Education*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?*YesNoIMPORTANT: A 2-week notice is required to submit a cake order with our friends at 4RiversType of Cake*VanillaChocolateRed VelvetCookie N' CreamType of Icing*VanillaChocolatePlease provide the name that you would like to be on the cake for the youth.Does the youth have any food allergies?*YesNoIf yes, please explain what type of food allergy that the youth has.*Please 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.*Number of people celebrating*2-910-19Is a gift being requested?*YesNoPlease 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 Release of InformationBy signing below, I approve the release of the confidential information provided in this referral to FFC, its contracted tutoring agencies and its funding agencies, including but not limited to, Orange County Commission for Children and Embrace Families.Electronic Signature: Release of Information*Please type first and last nameElectronic Signature: Release of Information By checking this box you accept this electronic signature. Photo/Testimony ReleaseFoundation for Foster Children Photo/Testimony Release: provides the Foundation for Foster Children (FFC) with permission to use photographs or testimonies provided in internal and external communications such as program newsletters and FFC marketing materials including, but not limited to, the website and print materials of FFC. Youth 18 and older must provide direct consent before services will be initiated. Consent must be provided by the caregiver, caregiver support, IL specialist, TSS, GAL or their respective supervisors before services will be initiated for youth 14-17.Photo/Testimony Release: Consent*I do give consentI do not give consentI do not have permission to provide consentPhoto/Testimony Release Statement* By signing below, I hereby give the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein. I understand that FFC may use photographs and testimonies in internal and external communications including program newsletters and FFC marketing materials including, but not limited to, the website and print materials. I understand that compensation in any form for the use of this likeness is prohibited. Photo/Testimony Release Statement* By signing below, I hereby do not give the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein. Photo/Testimony Release Statement* By signing below, I hereby am unable to give/deny the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein. Please provide the name, phone and email address of the individual with permission to provide/deny photo consent.Electronic Signature: Photo/Testimony Release*Electronic Signature: Photo/Testimony Release By checking this box you accept this electronic signature.