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Agency Request Form - Bloomington, IL
Select Your Agency
*
Select Your Agency
DCFS
The Baby Fold
CYF Solutions
McLean CAC
DCFS workers -- please note, if filling this form out via your DCFS computer, the form may not go through due to agency firewalls. Once the form is filled out, if you do not receive a confirmation email, please fill out the form via your phone.
Your Name
*
First
Last
Your Cell Phone Number
*
Your Office Phone Number
*
Your Email Address
*
What need(s) do you have?
Check all that apply
*
With each 'need' you choose, questions will drop-down below for follow-up information to be shared.
Tangibles: Journey Bags and Resources
First Response: Helps provide immediate needs you may have (mattress & bed, bedding, car seat, etc.)
Worker Appreciation Efforts: Coffee, flowers, food, notes of encouragement and projects all geared to show agency workers they are not alone.
Tangibles
Please mark any of the Tangibles that you are currently in need of:
*
Journey Bags - Diaper bags, backpacks, or duffel bags with personal & comfort items for children in foster care to call their own
Infant and Toddler Care Items - Basic care items needed commonly during transition times
Home Cleaning Kits - Cleaning supplies to help vulnerable adults or foster parents care for or welcome in children
Journey Bags
Diaper bags, backpacks, or duffel bags with personal & comfort items for children in foster care to call their own
What size Journey Bags do you need in GIRL bags?
*
None
0-3 Months
3-6 Months
6-9 Months
9-12 Months
12-18 Months
18-24 Months
2T
3T
4T
5/6
7/8
10/12
14/16
Adult Small
Adult Medium
Adult Large
Adult X-Large
What size Journey Bags do you need in BOY bags?
*
None
0-3 Months
3-6 Months
6-9 Months
9-12 Months
12-18 Months
18-24 Months
2T
3T
4T
5/6
7/8
10/12
14/16
Adult Small
Adult Medium
Adult Large
Adult X-Large
Infant and Toddler Care Items
Basic care items commonly needed during transition times.
What Infant and Toddler Care Items are you requesting?
*
Diapers for the Agency Resource Room
Pull-Ups for the Agency Resource Room
Wipes for the Agency Resource Room
Sippy Cups
Bottles
Pacifiers
Baby Gate
Night Lights
Outlet Covers
Door Knob Safety Covers
Cabinet Latches
Door Latches
What size diapers are needed?
*
Newborn (<10 lbs.)
1 (8-14 lbs.)
2 (12-18 lbs.)
3 (16-28 lbs.)
4 (22-37 lbs.)
5 (>27 lbs.)
6 (>35 lbs.)
What size Pull-Ups are needed?
*
2T-3T (18-34 lbs.) GIRL
2T-3T (18-34 lbs.) BOY
3T-4T (32-40 lbs.) GIRL
3T-4T (32-40 lbs.) BOY
4T-5T (38+ lbs.) GIRL
4T-5T (38+ lbs.) BOY
College Care packages
Care package for foster youth navigating their college experience with little to no support.
Please indicate what kind of support is needed.
*
Tangible Needs | Additional Information
Please indicate any details for the needed Tangible items you are requesting.
First Response
Helps provide immediate needs you may have (mattress & bed, bedding, car seat, etc.)
Desired deadline for the need to be met:
*
48 hours
4 days
1 week
2 weeks
Client Name
*
First
Which best describes your client(s)?
*
Teen in Foster Care
Relative Foster Parent
Reunified Family (with open case)
Intact Family (with open case)
Foster Parent
How many parents are in the home?
*
1 parent household
2 parent household
What is the expected reunification/move-in date?
*
Please list other resources you have explored to meet this need:
*
Description of Need: (please select the item(s) you need)
*
Car Seat(s)
Bed(s)
Bedding
First Response | Car Seat Specifics
What kind of car seat(s) are needed?
*
Infant Car Seat (5-22 lbs.)
Convertible Car Seat (5-22 lbs. rear-facing OR 20-65 lbs. forward-facing)
Boost Car Seat (40-65+ lbs.)
Quantity of Infant Car Seats Needed:
*
Quantity of Convertible Car Seats Needed:
*
Quantity of Booster Car Seats Needed:
*
First Response | Bed(s) & Mattress(s) Specifics
What bed size(s) is/are needed?
*
Crib
Twin Bed
Bunk Bed - Twin (Please Note: Bunk beds are to only be requested for children 4 years and older.)
Quantity of Cribs Needed:
*
Quantity of Toddler Beds Needed:
*
Quantity of Twin Beds Needed:
*
Quantity of Bunk Beds (twin) Needed:
*
What is needed for the bed(s) you selected?
*
Bed Frame
Mattress
Provide additional details if you have specific needs for the items selected.
First Response | Bedding Specifics
What size bedding is needed?
*
Crib
Toddler Bed
Twin Bed
Bunk Bed - Twin
What bedding is needed for the bed(s) selected?
*
Pillow
Sheets
Blanket/Comforter
Provide additional details if you have specific needs for the items selected.
Please give us more information about each individual needing bedding.
*
(Click (+) to add more rows/individuals)
Gender
Size Bedding Requested
Favorite Color
Favorite Characters/Interests
First Response & Tangible Need Pick Up Information
Note: We are unable to fulfill requests between November 24 - November 29th. Any requests made during that timeframe will be fulfilled beginning on November 30th.
Are you willing to pick up the requested tangibles from the TFI storage room in Bloomington at a specified time -- Tu/Th 8a-3p?
*
Please note, only agency representative are able to pick-up the requested tangibles. Clients are not able to pick-up.
Yes
No
When is your desired date and time for pick-up on Tu/Th 8a-3p??
*
If you prefer delivery, where should the item(s) be delivered?
*
Deliveries are Wednesday 12-2p.
Agency
Client's Home
Is your client willing to receive contact from TFI and those who will deliver?
*
Yes
Delivery Contact First Name
*
Delivery Contact Phone
*
Delivery Contact Relationship to Client
*
Delivery Address
*
Street Address
Address Line 2
City
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Armed Forces Americas
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State
ZIP Code
Project Sunshine
NOTE: This program is on hold until Illinois moves into stage 5 of Restore Illinois. You can still submit requests, but they will not be able to reviewed and processed right away.
What specific things would you like completed for this Project Sunshine? (Check all that apply)
*
Note: TFI cannot provide renovations (i.e., construction) in the office; only redecorating.
Paint
Decorations
Storage
Furniture
Activity Supplies (toys, books, art supplies)
Electronics
What are the dimensions of the room(s)?
*
Please include photos of the room(s).
*
Drop files here or
Please list any materials that have already been purchased or provided for the room(s).
Will any current furnishings or items be reused in the room(s)?
*
Yes
No
Please provide dimensions for furniture or storage containers that will be reused.
*
Please provide photos of those items to be provided/reused.
*
Drop files here or
What materials will The Forgotten Initiative need to provide?
*
Paint
Decorations
Storage
Furniture
Activity Supplies (toys, books, art supplies)
Electronics
Are there specific requests for furniture to be used in the room(s)? If so, please, describe with preference in size for each furniture item.
Who will be clearing the room(s) to prepare for the Project Sunshine?
*
Agency Personnel
TFI - Note: may require additional day of access to room(s); also, please note where items should be stored in the building or discarded. TFI cannot remove items from the premises.
The agency’s building is:
*
Owned by the agency
Leased by the agency
Please provide three 2-day time periods that a TFI team can have access to the building to complete the project.
*
Time Period Option 1
Time Period Option 2
Time Period Option 3
Who is the contact person for access to the building?
*
Contact Name
Cell Phone Number
Email Address
Will this person be available for questions on project day?
*
Yes
No
If not, please provide a backup contact for access to the building?
*
Contact Name
Cell Phone Number
Email Address
Worker Appreciation Efforts
Coffee, flowers, food, notes of encouragement and projects all geared to show agency workers they are not alone.
Please indicate what kinds of treats or encouragement the workers at your agency enjoy.
*
Miscellaneous
Would you like a TFI Representative to speak at a staff meeting?
*
Yes
Not at this time
Please indicate your desired date and time for the presentation.
*
Any other comments/concerns or needs?
Name
This field is for validation purposes and should be left unchanged.
The Forgotten
About Us
Overview
Our Beliefs
Our Story
Our Team
FAQs
Ways to Give
Make A Difference
Resources
Give
Careers
Blog
Podcast
Find a TFI Advocate
Become a TFI Advocate
Contact