School Supply Assistance Request

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School Supply Assistance Request

If you are in need of assistance providing backpacks and school supplies for your children, complete the application below.

The School Supply Assistance will be handled similar to a grant application. Completing an applications does not guarantee you will receive an award. One determining factor is the amount of funds raised to purchase the awarded supplies.

Target Schedule:

March 1, 2021 = Grant application window opens
May 31, 2021 = Grant application window closes
June 30, 2021 = Grant awards announced (no later than this date, hopefully earlier)
Aug 15, 2021 = Pick up backpacks and school supplies

Financial coaching and/or participation in financial workshops is a requirement of this scholarship. You may complete this prior to the beginning of the grant window. However, at least one financial coaching session or workshop must be completed prior to the close of the grant window.

School Supply Assistance Request

Complete the assistance application and school supply list. We will get back with you after the assistance requests have been awarded.

Contact Information - Step 1 of 4

Your Name *

First

Last

Your Email *

Your Phone *

Select the appropriate household status: *

Second Parent's Name *

First

Last

Second Parent's Email *

Second Parent's Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

The following questions provide information needed to complete the fundraising work that makes this program possible.

Select your household's annual Income range *

Are you (or your spouse) a veteran? *

Yes, I or my spouse are a veteran
No, not a veteran

Are you (or your spouse) on disability? *

Yes, I and/or my spouse are on disability
No, not on disability

If you were to purchase all the school supplies, would that put you at risk of being homeless? *

Please explain your situation *

How many children are in your family? *

How many children need school supplies? *

1st Child's Name *

First

Last

1st Child's birthday (copy) *

1st Child's School (full name of school) *

1st Child's Grade in Fall *

2nd Child's Name *

First

Last

2nd Child's birthday *

2nd Child's School (full name of school) *

2nd Child's Grade in Fall *

3rd Child's Name *

First

Last

3rd Child's birthday *

3rd Child's School (full name of school) *

3rd Child's Grade in Fall *

4th Child's Name *

First

Last

4th Child's birthday *

4th Child's School (full name of school) *

4th Child's Grade in Fall *

5th Child's Name *

First

Last

5th Child's birthday *

5th Child's School (full name of school) *

5th Child's Grade in Fall *

Enter name, birthday, school, & grade for each additional child *

Are you a current client of Moneytalk Financial Foundations? *

Yes, I am a current client
No, this is my first interaction with Moneytalk
No, but I have been a client in the past

In order to receive a school supply scholarship, participation in financial coaching or workshops is required. *

I understand / Acknowledge
No, I am not okay with this

Have you already completed a financial coaching session or workshop? *

Yes, I have completed this requirement
No, but it is scheduled
No, I need to schedule a coaching session
No, I plan to attend a workshop

Who referred you to us or this program? *

Anything else you would like to tell us?

The signature below will be considered your agreement and acceptance of the conditions of this program. *

Your signature is confirmation that all the information provided is true and complete.

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P O Box 860184, Shawnee, KS 66286

913-538-1465