GAL Funding Request

Guardian ad Litem 7 Foundation

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FUNDING REQUEST FORM

Email *

Name of Guardian ad Litem *

First

Last

Date of Request *

Phone Number *

Amount Needed *

Note that TAXES are NOT reimbursable.

Case File Number *

Child's First Name and Last Name Initial Only *

GAL Address *

Line 1

Line 2

City

State

Zip Code

Country

Choose the county of the child's case *

Flagler East Volusia West Volusia Putnam St. Johns

Shipping Instructions *

Option 1: No shipment required Option 2 Ship to GAL Option 3 Ship to Caregiver Option 4 Ship to CAM

Choose One *

This request is time sensitive and needs prompt attention. This request is needed by a specific date. (Show date in details.)

Have you spoken with your Child Advocate Manager (CAM) in search of available funding or other resources to meet this request? *

Yes No

CAM Name *

CPC Case Manager *

Reason for Funding Request *

Please give details of the purchase, plus ALL information you have gathered about the request.

Taxes are not reimbursable.

Items Detail *

Please supply color, size, Walmart stock number etc. to aid us in meeting this need.

What other funding or support sources have been explored.? Please include contact information for followup. *

GAL7 Foundation, Inc. prefers to make checks payable directly to the vendor from an invoice. Exceptions can be made on a case by case basis in order to meet the needs of the child. It is important we have an invoice/receipt for all expenditures to be in compliance with IRS regulations. ENTER Vendor to be paid below *

If approved, name of the company providing the service or supply with complete mailing address.

Submit

If approved for purchase, be sure to save your receipts which will need to be submitted to the Foundation.

"A COPY OF THE OFFICIAL REGISTRATION #CH42750 AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE."