Success Funding Request

This form is exclusively for youth working with an FFC Advocate. Funding may be approved in the following categories: career, housing, parenting, and transportation. FFC reserves the right to modify services and policies, at any time. As a policy, we do not reimburse. Processing usually takes 5-7 business days.

"*" indicates required fields

Advocate and Student Information

Month*

Year*

Who is submitting this request?*

Please specify if this request is being submitted by the student or the advocate

Who is your advocate?*

Advocate Processing*

Student Name*

First Last

Date of birth*

Age*

Gender listed on referral*

Ethinicty*

Placement*

Group home/Transitional Home Name*

Grade*

Zip Code*

County where youth resides*

Funding Categories*

Transportation

Housing

Career

Parenting

Youth Development

FFC Storage Unit

Transportation: Bus passes, Uber/LYFT gift cards, car payments, down payments, car insurance, car repairs, license or registration fees, tickets (parking/speeding), driving lessons, tolls, etc.
Housing: Rent assistance, application fees, electric bills, water bills, gas bills, furniture, moving expenses, housewarming baskets, cleaning supplies, etc.
Career: Interview attire, Uniforms, Equipment Fingerprinting, Drug testing, etc.
Parenting: Professional parenting classes, Childcare application & deposit fees, Parent-child bonding activities, etc.
Youth Development: Hygiene items, Groceries, Clothing items, Daily Living, Self-Care, etc.

Career*

Housing*

Parenting*

Transportation*

Youth Development*

If other, please describe*

Cost and Provider Information

Cost of Activity*

Enter 0.00 if taken from storage

Did the advocate pay for this already?*

Yes

Please select 'Yes' if you are taking a bus pass, gift card, or item from storage (already purchased by the program).

Activity Provider or Brand Name*

Please attach any relevant documents to this request.

Max. file size: 50 MB.

Additional notes. Please share any important information needed to process this request. For example, URL link for purchase, account information such as username and password, contact person related to this request, etc.*

In-Kind Information

Item(s) Description and Numerical Amount*