GAL Funding Request

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Guardian ad Litem 7 Foundation

FUNDING REQUEST FORM

* Indicates required field

GAL 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 *

Requests without the complete name of the child cannot be processed.

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

Date Needed (Format: 01/01/2018) *

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.

If your request is $500 or more, 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. Please attach a copy of your Funding Request approval email to your receipts prior to submitting receipts.

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