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Needs Form (Clothing & Items for Children, Teens – in foster care, and for Young Adults who have aged out of foster care)
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Supporting Foster Families with our for free resources, as they help
“Look After”
the children we serve in the foster care community of NEFL.
Needs Form (Clothing & Items for Children, Teens – in foster care, and for Young Adults who have aged out of foster care)
"
*
" indicates required fields
If you are a foster caregiver, GAL, FSC, CPI, or Pathway young adult and needing Foster Closet's Free resource, fill out this form with the Name of Person making appointment and picking upfor child/children their care: (Please email us
[email protected]
once you have filled out your form.)
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Who is the caregiver, FSC worker, GAL making this appointment for this child? Who will be picking up the items for this child? We are sorry if we cannot provide everything being asked on this form.
I am a:
*
Foster Parent
Kinship
Non-Kinship
FSC
CPI
GAL
Group Home
Pathway
Host Family (Safe Families for Children)
Better Together
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Which location is this appointment for?
*
Northeast Florida/Jacksonville
How many children need items?
*
1
2
3
4
First Child Information (Or Pathway Needing Clothing)
Age
*
Age Type
*
Years
Months
Gender
*
Male
Female
Clothing Size
*
Shoe Size
*
Any additional items needed: (Diapers, Bike Size, Items toys they like)
Second Child Information
Age
*
Age Type
*
Years
Months
Gender
*
Male
Female
Clothing Size
*
Shoe Size
*
Any additional items needed
Third Child Information
Age
*
Age Type
*
Years
Months
Gender
*
Male
Female
Clothing Size
*
Shoe Size
*
Any additional items needed
Fourth Child Information
Age
*
Age Type
*
Years
Months
Gender
*
Male
Female
Clothing Size
*
Shoe Size
*
Any additional items needed
Northeast Florida Details
With what Agency are you licensed?
*
Family Support Services
Daniel
NYAP
Family Integrity Program (St. Johns County)
Kids First (Orange Park)
Partnership for Strong Families (High Springs/Gainesville)
CHS
Safe Families
Better Together
When did each child come into your home? (Child #1_/Child#2_/Child#3_/Child#4_)
*
Household Information
If Foster Home, Who is the Agency the caregiver is licensed
*
Family Support Services - DUVAL
Family Support Services - NASSAU
FIP/ Family Integrity Program (St. John's County)
KFF/ Kids First of FL (Clay County)
CMS (Children's Medical Services) FSS
Daniel (Theraputic)
NYAP (National Youth Advocate Program of Jax)
FSC Worker for a Duval / Nassau County Child
FSC Worker for a Child out of Duval County
GAL for a Duval / Nassau County Child
GAL for an out of county chlid (other than Duval)
Better Together
Other/Specify
** We are not able to help OMC unless the child/children are placed in Duval through FSS placement. Please let us know.
How many family members in total live in your home?
*
2
3
4
5
6
7
8
9
10+
How many times have you used Foster Closet for this placement?
*
1
2
3
4
5
6
Since being in your home.
Case Manager/Counselor Information
Each Child's FSC worker (Case Manager's) AGENCY or DCF/CPI Info (Child#1_/ #2_/ #3_/ #4)_
*
If there are multiple Caseworkers : Child 1_ / Child 2 _/ Child 3_ / Child 4_
Each FSC Worker (Case Manager's) or DCF/CPI's First and Last Name: (Child #1,#2,#3, #4)
*
First & Last Name of Each Child's FSC worker (Case Manager's) or DCF/CPI Info (Child#1_/ #2_/ #3_/ #4)_
Phone Number for Each Child's FSC (Casemanager) / DCF CPI (Child #1 _/Child #2_/ Child#3 _/ Child #4_)
*
Cell Number of Each Child's FSC worker (Case Manager's) or DCF/CPI Info (Child#1_/ #2_/ #3_/ #4)_
Each Child's FSC worker (Case Manager's) or DCF/CPI's Email: (Child #1, #2, #3, #4)
*
EMAIL of Each Child's FSC worker (Case Manager's) or DCF/CPI Info (Child#1_/ #2_/ #3_/ #4)_
Confirmations
Documentation Required
*
I understand that I must bring proper documentation in order to receive the items for my child(ren).
If you have forgotten what you must bring look at The Who Qualify's Page
Children Must Be Present
*
We are not able to have children/teens try on clothing at this time. However, when we do, I understand that tweens and teens must come in to Foster Closet and it will take on hour to shop.
Items Belong to the Child(ren)
*
I understand that all items given by Foster Closet will Permanently go with the child(ren).
Please
Note
Sadly, we are not up and running like usually, however, we do our best to help.
If you have more than 4 children, please fill out two forms.