Dream Fund Application

The Dream Fund helps providers from CCC partner agencies access resources to help clients with children (ages 5-18) with financial barriers reach their dreams. Applications need to be submitted by staff providers and all communication is between the provider and the Dream Fund Committee.

General Information
Provider Name*
Provider Email*
Provider Agency*
Provider Phone*
Client/Family Name*
Client/Family physical address*
Total dollar amount of request*
Ages of children must be 5 to 18 years old*
age of child 1 age of child 2 age of child 3
Request/Dream Information
History*
Please provide a brief family history and describe the dream
Resources available that currently support this dream:
(please be specific)
Scholarships Equipment Instructor/mentor/coach Supplies Transportation Uniform Other agency support Others
How can the funding make a difference to the child(ren)?
(Please check all that apply)
- Promotes Resiliency
- Supports their passion
- Increases physical activity
- Supports positive relationships with peers
- Supports positive relationships with caring adults
- Increases access to nature
- Increases access to arts and culture
- Increases access to fun
- Promotes Joy
- Other (please describe below)
Other
Please be specific
Please categorize your request according to the following areas
Supplies & equipment Lessons (how many) Camps/programs (dates) Travel expenses (gas, meals, etc.) Other expenses (please list below)
Is the applicant requesting any of the items listed below?
- Yes
- No
1) Laptop Computer 2) Desktop Computer 3) Tablet 4) Adaptive device, such as a screen reader to aid in meaningful digital accessibility
Is the applicant's income at or below 200% of Federal Poverty Guidelines?
- Yes
- No
Select which population the applicant falls under:
- Rural
- Age 60+
- Individual with disability/disabilities
- Recently incarcerated
- ESL/low literacy
- Person of color/member of an ethnic group
- Low income
- None of the above
Additional Documentation
All requests must include supporting materials showing the cost of an estimate of the costs for this dream (e.g., an estimate, advertisement or brochure outlining the fees). If combining Dream Fund with other resources, you must fill out the Combined Funding Budget form below. Share any information you think the committee should know when making a determination.
Upload documents here
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, xls, docx, xlsx, , Max. file size: 32 MB.
Tips for uploading documents
If your client needs to submit a photo of a bill as part of the family's application, ask them to use the flash when taking the photo, and to email you the photo (large size is best) instead of texting you, if possible. Emailed photos are much clearer than texted photos which can be very hard to read.
Combined Funding Budget Form
Use only if you are combining your request from other sources. Only fill in the line items that apply to this request/need. Total costs must equal total funding. Do not fill this out if the Dream Fund is the only funding source for the request/need. To use this form, click on the link below and download to your computer and save. Fill out the form & download, then use the back arrow to return to the Dream Fund application. Upload your completed combined budget form with other supporting documentation in the space provided above.
Please click to complete the combined funding budget form.
Payment Information
must be completed
Vendor/Instructor/Organization
Address
Street Address Address Line 2 City State ZIP Code
Contact for follow-up Survey
Dream fund recipients are invited to complete and return a survey which will help the CCC capture the actual impact of the Dream Fund. The survey will be mailed out within 3 months after the funds have been disbursed.
Client/Family Signature*
please print your name - this will be your e-signature
Client/Family Email
Provider Signature*
Please print your name - this will be your e-signature
Date
MM slash DD slash YYYY
Please Note:
A multi-agency committee of the Community Caring Collaborative reviews applicant information. The CCC encourages providers to arrange for necessary releases of information.
- I have read this notice.
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Email
This field is for validation purposes and should be left unchanged.

Translate »

Scholarships	Equipment	Instructor/mentor/coach	Supplies	Transportation	Uniform	Other agency support	Others

Supplies & equipment	Lessons (how many)	Camps/programs (dates)	Travel expenses (gas, meals, etc.)	Other expenses (please list below)

age of child 1	age of child 2	age of child 3

Dream Fund Application

General Information

Request/Dream Information

Additional Documentation

Tips for uploading documents

Combined Funding Budget Form

Payment Information

Contact for follow-up Survey