Agency Request Form - Colquitt County, GA

Select Your Agency*

Worker's Name*

First Last

Worker's Title*

Worker's Email*

Worker's Phone*

Who is this request for?*

Child in Foster Care
Agency Worker
Young Adult in Care (living independently)
Bio Parent (in reunification process)
Foster Parent

CHILD IN FOSTER CARE SUPPORT

What are you requesting for a child in foster care?*

If needed, click each option to read a description.

Celebration Packs
Recognition Reward (for child in care)
Bed(s)
Special Request

Has your supervisor given you permission to submit a Bed Request?*

We are only able to provide beds once permission has been granted by your supervisor.

Yes
No

Celebration Packs

We are so excited to celebrate family adoptions and reunifications with you and the families you serve! How it works: 1. Each family will receive a meal gift card to celebrate together as a family. 2. Each child in DFCS custody (being adopted or reunified) will receive a Celebration Pack specialized to them and their interests.

This is for a family:*

Adoption
Reunification

What is the adoptive family's last name?*

What is the reunifying family's last name?*

How many parents are in this family?*

One parent home
Two parent home

Please give us more information about each child in DFCS custody so we can pack each celebration pack special for them!*

Click the (+) to add more additional rows for more children.

Child's Initials	Age	Gender	Interests	Allergies

Please share any additional information you'd like us to know.*

If none, please type N/A.

Family's favorite fast food restaurant:

If not specified, a Pizza Hut gift card will be given.

Which fast food restaurant would the family prefer a gift card to?*

Pizza Hut
Dominos
McDonald’s
Zaxby’s
Burger King
Other Local Fast Food Option

Which "other" fast food restaurant would the family prefer a gift card to?*

Please note: There is an allotted amount per family. Please do not submit a request for a sit-down restaurant.

How many total people are in this family?*

Please include all adults and children (biological, adopted, foster, etc.)

What is the reunification date?*

What is the adoption court date?*

What is the preferred delivery deadline from TFI?*

Where should the Celebration Pack be shipped?*

Street Address Address Line 2 City GA ZIP Code

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How does the Celebration Pack need to be packaged?*

TFI will deliver to DFCS Office.

Hand delivered gift
Shipped gift

Recognition Reward (for child in care)

Do you have a child in foster care on your caseload that is doing well and you’d like to recognize? Let us know, TFI would love to help you celebrate him/her!

Please give us information about the child in DFCS custody that you are requesting a Recognition Reward for.*

Child's Initials	Age	Gender

Why are you choosing to give this child in DFCS custody a Recognition Reward?*

What kind of reward are you requesting for this child?*

Examples: Gift card, special purchase, experience, etc. Please note, we do our best to meet each request based on our current budget but we may need to modify the request. You will be contacted by TFI if modifications for this request are necessary.

Please share any additional information you'd like us to know.*

If none, please type N/A.

What is the preferred delivery deadline from TFI?*

How does the Recognition Reward need to be packaged?*

TFI will deliver to DFCS Office.

Hand delivered gift
Shipped gift

Bed Request

TFI's Bed Project helps you (DFCS) place kids in families and equip the family with the necessary bed(s) and bedding.

Has this child received a bed from TFI's Bed Project in the past?*

Yes
No

The goal of TFI's Bed Project is for each bed to stay/move with the child it was originally given to. Please explain why the child no longer has the bed and why you're requesting a new one.*

What bed size(s) is/are needed?*

Each bed will be provided with a bed frame, mattress, and mattress cover.

Crib
Toddler Bed
Twin Bed
Bunk Bed - Twin over Twin
Bunk Bed - Twin over Twin with Trundle
Bunk Bed - Twin over Full
Full Bed

Quantity of Cribs Needed:*

Quantity of Toddler Beds Needed:*

Quantity of Twin Beds Needed:*

Quantity of Bunk Beds (twin over twin) Needed:*

Quantity of Bunk Beds (twin over twin with trundle) Needed:*

Quantity of Bunk Beds (twin over full) Needed:*

Quantity of Full Beds Needed:*

Is bedding also needed?*

Yes
No, I'm okay.

What size bedding is needed?*

Crib
Toddler Bed
Twin Bed
Bunk Bed (Twin over Twin)
Bunk Bed (Twin over Twin with Trundle)
Bunk Bed (Twin over Full)
Full Bed

What bedding items are needed for the bed(s) selected?*

Pillow
Sheets
Blanket/Comforter

Please give us more information about each individual needing bedding.*

(Click (+) to add more rows/individuals)

Bed Size	Gender	Favorite Color	Favorite Characters/Interests

Where should the bed(s) be delivered?*

DFCS - 449 N. Main St., Moultrie, GA 31768
Foster Family's Home

Will TFI volunteers need to assemble the bed(s) upon delivery?*

Yes
No, I'm okay.

Delivery Contact First Name*

Delivery Contact Phone Number*

Delivery Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Special Request (for child in care)

Examples of a Special Request: Emergency clothing request, senior graduation celebration, extra resources for a child with special needs, etc. Please note: All requests will be considered, but we cannot promise to meet every request.

Have you reached out to any other ministries or community resources to meet this need?*

Yes
No

If yes, what ministries or community resources have you reached out to?*

Please give us information about the child in DFCS custody that you are submitting a Special Request for.*

Child's Initials	Age	Gender

What is the Special Request and why are you in need TFI's support for it?*

Please share any additional information you'd like us to know.*

If none, please type N/A.

What is the preferred delivery deadline from TFI?*

How does this Special Request need to be packaged?*

TFI will deliver to DFCS Office.

Hand delivery
Shipping

DISCLAIMER

If you have not reached out to other ministries or community resources, we will still review your request but in order for us to best honor our donors, it is important we utilize all community resources in the areas they specialize in.

YOUNG ADULT IN CARE (LIVING INDEPENDENTLY)

We would like to offer support to young adults (YA) in foster care living independently. Please fill out the form below. We will contact you to discuss scheduling for outreach to this youth.

Have you received permission from this YA to request support from TFI for them?*

Yes
No

What are you requesting for a young adult in foster care?*

If needed, click each option to read a description.

Support Package
Special Request

IMPORTANT: Please receive permission from this family before submitting this information.

Young Adult Support Packages

Support Packages can include items such as: hygiene items, cleaning & laundry supplies, paper goods, etc. TFI's hope in providing this support is to alleviate some financial strain that comes with living independently.

YA's Name*

First

Please check all that apply:*

Full-time student
Part-time student
Working full-time
Working part-time
Other

Please share additional information for your "other" choice above.*

When is this YA's birthday?*

What city is the YA currently residing?*

How often is this Support Package needed?*

One-time
Monthly
Quarterly

How does this YA Support Package need to be packaged?*

TFI will deliver to DFCS Office.

Hand delivery
Shipping

Please list the items that should be included in this YA's Support Package.*

Support Packages can include items such as: hygiene items, cleaning & laundry supplies, paper goods, etc.

Young Adult Special Support Request

Examples of a Special Request: Emergency clothing request, college graduation celebration, extra resources for a young adult with special needs, etc. Please note: All requests will be considered, but we cannot promise to meet every request.

Have you reached out to any other ministries or community resources to meet this need?*

Yes
No

If yes, what ministries or community resources have you reached out to?*

Please give us information about the YA in DFCS custody that you are submitting a Special Request for.*

YA's Initials or First Name	Age	Gender

What is the "Special Support" you are requesting and how do you feel this Young Adult will benefit from it?*

Please share any additional information you'd like us to know.*

If none, please type N/A.

What is the preferred delivery deadline from TFI?*

How does this Special Request need to be packaged?*

TFI will deliver to DFCS Office.

Hand delivery
Shipping

DISCLAIMER

If you have not reached out to other ministries or community resources, we will still review your request but in order for us to best honor our donors, it is important we utilize all community resources in the areas they specialize in.

AGENCY WORKER SUPPORT

Agency Worker Recognition

An Agency Worker Recognition needs to be requested by a supervisor.

Are you a supervisor?*

Yes
No

What is the name of the worker being recognized?*

First Last

Does the Agency already have any outreach for this worker planned?*

Yes
No

If it is on a specific date, when is this outreach planned for?

Where and how do you plan to recognize the worker?*

What occasion are you requesting to be recognized?*

Note

TFI is only able to accept Agency Worker Recognition requests from supervisors. Please share this information with an agency supervisor and have them fill out this form.

Marriage

When is the Big Day?*

Where is the couple registered?*

What are their wedding colors?

Pregnancy/Birth

Due date or birthdate of the baby?*

What is the baby's gender?*

Girl
Boy
It's a surprise!

If the baby's name is being shared, what is it?

What is the theme and color of the nursery?*

In-house Promotion

What is the worker's new title?*

When is the official start date?*

Retirement

When is the last official day at work?*

How long has this person worked at the agency?*

Death

Funeral Home Information*

What is the address where the family will be gathering?*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

BIO PARENT SUPPORT

What are you requesting for a bio parent?*

If needed, click each option to read a description.

Tangible Need

Tangible Need Request

Tangible requests will only be considered if part of DFCS reunification plan for parent. Please note: We cannot promise to meet every request.

Identify this parent by name, initials, or case #*

Have you reached out to any other ministries or community resources to meet this need?*

Yes
No

If yes, what ministries or community resources have you reached out to?*

Please share in detail about the tangible need you are requesting and how it will impact the outcome of the parent's reunification process.*

DISCLAIMER

If you have not reached out to other ministries or community resources, we will still review your request but in order for us to best honor our donors, it is important we utilize all community resources in the areas they specialize in.

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Jail Inmate Support Packet Request

This request applies to bio parents who are currently working a case plan with DFCS and also incarcerated. Packet includes: Bible, devotional, stationary & stamps, list of community resources, description of support TFI provides. Packets will need to be delivered by the case manager to the facility. We will need to have permission cleared between you and the incarcerating facility for us to have future interaction with this inmate. Please research these requirements and follow through with clearance prior to submitting this request.

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Inmate's Name*

First Last

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Inmate ID #*

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Inmate's Gender*

Male
Female

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What facility is this bio parent incarcerated at?*

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Additional support:*

TFI is only able to offer additional support in Colquitt County at this time.

No, my client would not like additional support.
Yes, please connect with me regarding additional. support for my client.
My client is not in Colquitt County.

FOSTER PARENT SUPPORT

Have you received permission from this foster family to give TFI their contact information regarding this request?*

Yes
No

What are you requesting for a foster family?*

New Foster Home TFI Registration
New Placement Support
SOS Foster Family Support
Birthday Support

IMPORTANT: Please receive permission from this family before submitting this information.

New Foster Home TFI Registration Referral

TFI strives to support all of Colquitt County's foster families. We have all foster families "register" with TFI so we can receive all the important information for us to serve them well. If you'd like to make us aware of a new foster home, and have their permission to, please fill out the information below and we'll send them an email to register!

Name*

If there isn't a second parent, type n/a in "First (Parent 2)"

First (Parent 1) First (Parent 2) Last

Email*

Cell Phone*

New Placement Support

We would love to support all foster parents regardless of location as they receive a new Colquitt County placement. If you have foster parents who are willing to receive contact from us--please list their information below. We will then reach out to them to see how we can help with meals, clothing needs, etc. to help their transition in welcoming kids into their home.

Foster Parent's Name(s)*

If there isn't a second parent, type n/a in "First (Parent 2)"

First (Parent 1) First (Parent 2) Last

Cell Phone*

Can TFI text this phone number?

Yes
No

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Information of new placement:*

If you need to add additional children, click the (+) to the right of the first line and more lines will appear. Please share as much information about the child as possible. If you don't know, put n/a.

Child's First Initial	Gender	Age	Grade	Clothing Size	Shoe Size

Are there specific resources you are aware of this family could benefit from during placement/transition?

SOS Foster Family Support

TFI offers additional support* for foster families during challenging seasons. *All requests for additional support will be considered and met as our resources allow.

Foster Parent's Name(s)

If there isn't a second parent, type n/a in "First (Parent 2)"

First (Parent 1) First (Parent 2) Last

Cell Phone*

Please share as much information about this family's challenging season as possible and how you hope TFI can support them.*

Can TFI text this phone number?*

Yes
No

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Birthday Support

This outreach is contingent on continued sponsorship. Birthday Support includes a gift card to help support the purchase of a birthday cake for a child in foster care.

Where would the foster parent like a gift card to for the purchase of a birthday cake?*

Walmart
Piggly Wiggly
Dairy Queen
Publix

Address*

Gift Cards will be mailed to the foster family.

Street Address Address Line 2 City State ZIP Code

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FUMC

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Who are you requesting for?*

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What are you requesting?*

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How will this be delivered?*

Pick up from church
Deliver to agency
Deliver to recipient

If you are planning a church pick up, please contact Pastor Rich at [email protected] to coordinate details.

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Recipient Name*

First Last

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Recipient Phone*

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Recipient Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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What is the preferred delivery deadline?*