Agency Request Form - Bloomington, IL | The Forgotten Initiative

Select Your Agency*

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?*

What size Journey Bags do you need in BOY bags?*

Infant and Toddler Care Items

Basic care items commonly needed during transition times.

What Infant and Toddler Care Items are you requesting?*

What size diapers are needed?*

What size Pull-Ups are needed?*

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)?*

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 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.

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?*

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.