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CAPC Sue Fleischner Special Needs Fund 
The Child Abuse Prevention Council (CAPC)'s Sue Fleischner Special Needs Fund is available once per family to families in need. Special needs items may include (but are not limited to): transportation, clothing supplies, school and work uniforms, diapers, strollers, safe cribs, utility bills, medical supplies, birth certificates, eyeglasses, weighted blankets, prescriptions, tablets for school, and hygiene products. 

To be eligible for special needs items, families must have at least one child between the ages of 0-18 living with them. Please note that funding is available once per family and that this is not designed to be emergency assistance - items may take a few days to prepare for pick up.

To request an item, please complete the following google form and submit it. The form must be completed by a service provider (not a family member). CAPC will call or email to arrange for the service provider to pick up the items from our Concord location at 2120 Diamond Blvd., #120, Concord, CA 94520. For questions or for more information, please email Sofia Stanwood at sstanwood@capc-coco.org
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Service Provider Name *
Requesting Agency *
Service Provider Email *
Service Provider Phone
Total Number of Children in the Household *
Primary Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian's Name *
Family's Address *
City *
Zip Code *
Primary Language Spoken in the Home
Item Needed (If requesting a utility bill, please email a copy of the bill to sstanwood@capc-coco.org)
Statement of Family Needs/Situation (Please elaborate on how this aid can support the needs)
 *
Family Plan (Please elaborate on how family will meet this need in the future) *
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