Application for Assistance | Case Management

Financial Assistance Questionnaire

TO BE CONSIDERED FOR A GRANT, CANDIDATES MUST FIRST COMPLETE THE CASE MANAGEMENT APPLICATION AND SPEAK WITH A CASE MANAGER

What Type of Financial Assistance/Grants are Available?

Financial assistance may be provided for adoption-competent therapy, tuition and school-related expenses, job counseling and job search-related expenses, or interim job-related expenses, such as transportation or child care.
If an applicant has a need that is not listed above, they should discuss with their case manager to determine if that need is something that could be grant-eligible.
All applicants must be enrolled in our case management program and be working with a case manager in order to network services and find strategies that are long-term and comprehensive.

Are There Any Types of Financial Assistance Requests Which You Do Not Grant?

Funds are not intended for crisis or emergency assistance including emergency rent (due within 14 days), past due bills/old debt or car repairs/purchases.
Funds may not be used for expenses related to pregnancy or adoption.
Funds are not intended to replace funds from ongoing programs such as Medicaid, Section 8 housing assistance, food stamps, or scholarships, but rather to be an interim or supplemental source of assistance to birthparents.
On Your Feet may choose to deny grant requests that involve tuition being paid to for-profit institutions.

How Much Assistance Do You Provide?

Grants are evaluated on a case-by-case basis. The typical grant is <$1,000.

How Are Assistance Decisions Made?

On Your Feet Foundation makes decisions based on the financial and emotional needs of the birthparent applicants.
Applications are submitted in cooperation with your case manager and decisions are made based on the need, long-term impact of the grant and available funds.
All applications are evaluated by our case management team, Executive Director and members of our Grants Committee.

How Long Does It Take To Get Assistance?

Applicants will be notified within two weeks of submitting a completed application and having an interview with a case manager from On Your Feet Foundation. Grants take 2-4 weeks to fund.

Who Receives the Funds?

Similar to adoption assistance, funds will be disbursed to the organization actually providing services. For example, test-taking fees would be sent on your behalf by On Your Feet Foundation to the test provider; counseling grants are paid directly to the therapist and rent is paid directly to the landlord.

Where do I return the application when completed?

Applications can be completed and submitted on our website. If you are unable to complete the application online, please contact your case manager for assistance:
- Jennifer Adams
- Katy Finn

Applicant’s Name

First Name *

Last Name *

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Email (Required)

Phone (Required)

Race/Ethnicity (please check all that apply):

Black/African American
Hispanic/Latinx
Asian
Native Hawaiian/Other Pacific Islander
Indigenous Peoples/First Nations/Inupiaq/Inuit
White/Caucasian
Other / Prefer not to say

Date of Birth (Required)

Which Adoption Agency or Attorney handled the adoption? (Required)

(Name of Agency/Attorney, Adoption Counselor Name, Phone/Email)

Is there anything else you would like to tell us?

Financial Assistance Questionnaire

How many years of school have you completed?

Area of study/major, if applicable.

Are you currently employed?

If Yes, please list your occupation (Required)

Employer (Required)

How Long (Required)

Estimated net monthly income (Required)

Please list past employment experience, including types of jobs and skills you possess (Required)

If married, spouse’s occupation:

Employer

How Long

Estimated net monthly income

Are you living

Alone
With your children
With your parents
Other

How many children? (Required)

Specify other

Number of Dependents (Required)

Names(s), ages (s) and relationship(s)

Are other adults in your household sharing living costs?

If Yes, explain

Have you ever been arrested and convicted of a crime?

If yes, explain

(This does not mean that you will not be eligible for a grant but is important for us to assess your needs.)

Are you receiving any help from the following sources?

Parental support
Rent Assistance
Food stamps
Educational Scholarship
Place of worship
Housing Authority
Student Loans
Medical Card
Other

Do you receive:

TANF
Unemployment
Social Security
None of the above

If so, please list each with how much per month. (Required)

What is your current monthly income, including salary, child support, and any other income? (Required)

What are your monthly expenses? Include housing, food, utilities, telephone, transportation, child care, laundry, clothing, insurance, credit card and other debt, etc. (Required)

Please list here three people who we may contact to receive a personal reference about you. (Required)

(Non-family members only). Please provide name, phone number and relationship to you.

Explain what type of assistance you are requesting from On Your Feet Foundation. (Required)

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Date assistance is needed? (Required)

Please note, grant requests take 2-4 weeks to review and approve.

What is the amount requested? (Required)

Please itemize all costs.

If you receive the funds, please list at least three of your goals over the next 6 months, and how you would accomplish these goals. (Required)

What do you see yourself doing in five years? (Required)

Have you previously received a grant from On Your Feet Foundation? If yes, please provide detail. (Required)

Release of Information

This release does three basic things: it gives us permission to contact your agency, whom we depend on for referrals; it allows us to use your non-identifying information in our statistical analysis to evaluate the effectiveness of our services and to obtain funding from donors; and it enables us to collaborate as a team to provide the best services to you. If a grant is awarded, it also enables us to communicate with the school, therapist or property manager in order to execute payment of the grant.

I, name entered below, give permission to On Your Feet Foundation to exchange or release information regarding adoption services. I also give permission for On Your Feet Foundation to contact references and the adoption agency that provided services during pregnancy and adoption placement.

If I am awarded a grant, I give permission to On Your Feet Foundation to contact the appropriate entities in order to execute the grant (property agents/landlords, university registrar offices, therapists, etc). and that funds will only be paid directly to those entities. On Your Feet Foundation will never disburse funds directly to a grantee for any purpose. I also understand that failure to adhere to the terms of the grant may result in forfeiture of payments or future grants.

I am aware that On Your Feet Foundation is in the process of gathering research data and some of the statistical information gathered may be used for research. I am also aware that signing this release allows my adoption story to be shared in likeness in On Your Feet Foundation printed materials and/or website/social media pages. No confidential data or identifying information such as names and addresses will be used for this purpose without my express, written consent.

By signing this release, I understand this allows all pertinent On Your Feet Foundation personnel/staff to collaborate on my behalf as a team, to provide the best services deserved to me.

Signature

First Name *

Last Name *

Date (Required)