Opportunity Fund Application

(No retroactive reimbursement for completed activities)

Child’s Name:

Child’s Age:

Child’s Street Address:

Child’s City/State:

Child’s Zip Code:

Social Worker’s Name:

Social Worker’s Phone Number:

Social Worker Email Address:

Name of Person Requesting Funds:

Relationship with the Foster Child:

If request is submitted by Foster Parent, attach Foster Parent Agreement form for placement verification:

Phone Number:

Email Address:

Brief Explanation of the activity/request:

Activity Start Date:

Registration Deadline Date:

Name of Entity:

Address:

Phone:

Total Cost:

Does the organization offer any scholarships or discounts for foster youth? You must contact the organization before submitting this application:
Yes, total cost includes discount or scholarshipNo, the organization does not offer discounts or scholarships

Have you received any funding from Contra Costa Foster Friends during this calendar year? If
yes, please specify the amount:

If approved, Contra Costa Foster Friends will pay the cost directly to the provider. Please
attach a copy of a flyer or invoice. If you have already paid, please attach proof of payment: