Family Emergency Request Form
Please note, that we are taking requests for $250.00 or less. Higher amounts may be requested and will be considered on a case by case basis. We do not provide cash assistance.
Once submitted, you will be contacted within 24 to 48 hours.
Request submitted by:
School Liaison or family coordinator
Family needing assistance
If a School Liaison or family coordinator, please provide your name and contact information.
Please answer the following questions for the parent requesting assistance
Best Phone Number to Reach You.
May we text you?
What are the name(s) of your child(ren)?
What grades do they attend?
Preschool or Headstart
7th - 9th grades
10th - 12th grades
School District Your Children Attend
Employed Full Time
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This form was created inside of Community Building Institute.