Request edit access
Childcare Funding Request
Please submit the following information so we can determine if your request can be funded. Politisit reserves the right to determine whether or not to fund this request based on our mission, priorities, and available resources. Please provide as much information as possible so it can be properly evaluated. We will evaluate the request as quickly as possible, so please understand requesting at least 72 hours in advance is appreciated. Politisit pays for care at the caregiver’s local market rate. Should Politisit fund your request, Politisit reserves the right to check that the event was attended as outlined in the request.
Your Name
Your answer
Name of Event
Your answer
Date of Event
MM
/
DD
/
YYYY
Time of Event
Your answer
Location of Event
Your answer
Purpose of Event
Your answer
Amount Requested for Childcare
Your answer
Name of babysitter
Should you need to provide this information at a later time, please do so before the event so that we are able to reimburse you.
Your answer
Please provide any further information you would like Politisit to consider about your request
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms