Application for Beds for Kids

Thank you for your organization's interest in Beds for Kids. Any funding requests must be made by an organization on behalf of a family or individual. Please complete the brief application. There are two sections, Organization Information and Request Information. You are able to work on the application, save it and return to it at a later date.

NON PROFIT ORGANIZATION INFORMATION

THIS SECTION MUST BE FILLED OUT BY A NON-PROFIT ORGANIZATION

ON BEHALF OF THE INDIVIDUAL OR FAMILY REQUESTING BED NEEDS

NON PROFIT Organization Name*

NON PROFIT Organization Address*

Address Line 1

Address Line 2

City

State

ZIP Code

NON PROFIT Organization Mission Statement

Qualified Organizations must be legally organized 501c3 and have a mission of family service and ministry.

Organization Contact Name*

First Name

Last Name

Organization Contact Phone Number*

Organization Contact Email*

Total Number of families being served by this request*

Total Number of Beds Requested*

Total Number of cribs requested*

Family 1, Number of Beds*

Family 1, Number of Cribs*

Family 1, Age(s) of Child(ren)*

Family 1,Town and State of Residence*

Family 2, Number of Beds

Family 2, Number of Cribs

Family 2, Age(s) of Child(ren)

Family 2,Town and State of Residence

Family 3, Number of Beds

Family 3, Number of Cribs

Family 3, Age(s) of Child(ren)

Family 3,Town and State of Residence

Family 4, Number of Beds

Family 4, Number of Cribs

Family 4, Age(s) of Child(ren)

Family 4,Town and State of Residence

If more than 4 Families, please complete information on number of beds, cribs, and ages of children in box below for additional families

Story Sharing- Current Situation of Family(ies)*

for example, moving out of shelter, reunification of family, etc.

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