Treehouse - Funding Request Form

Does the person in need of services have a current Treehouse enrollment?*

Please select the enrollment status of the person you are requesting services on behalf of.

Treehouse can only offer services to participants with a current Treehouse enrollment.

To get a Treehouse referral or to check on the status of a referral request, please contact Treehouse's Intake Department at [email protected] or 206.267.5144.

Referrals
Eligibility

Relationship Details

Relationship to Participant*

Select the option that best describes your relationship with the participant.

If other was selected, describe relationship:*

Your Information

Your Name*

Please enter your name to help us process this request.

First and Last Name

Your Date of Birth*

Please enter your date of birth.

Caseworker Name

Enter DCYF, Tribe, or Federal caseworker name. Enter “unknown” if you are unsure of this information.

Caseworker Email

Enter “[email protected]” if you are unsure of this information.

Contact Information

Your Email*

Please enter your email so that we can provide you updates on your request. You should receive a response from Treehouse staff within 2-3 business days about the status of your request.

Your Phone Number

If you have a phone, please add your phone number so that we can call you in addition to emailing.

Select Your Preferred Contact Method*

Please select the method in which you would like Treehouse staff to contact you once the request has been submitted.

Your Information

Your Name*

First and Last Name

Your Email*

Please enter your email so that we can provide you updates on your request. You should receive a response from Treehouse staff in 2-3 business days.

Your Phone Number

If you have a phone, please add your phone number so that we can call you in addition to emailing you or the youth.

Select Your Preferred Contact Method*

Please select the method in which you would like Treehouse staff to contact you once the request has been submitted.

Participant Information

Participant Name*

First and Last Name

Participant's Date of Birth*

Please enter the first and last name of the partcipant you are requesting services on behalf of.

Is the participant currently working with a Treehouse support person in our Graduation Success, Launch Success or Education Advocacy programs? If so, please include their name here.

Leave blank if unsure.

Caseworker Name

Enter DCYF, Tribe, or Federal caseworker name. Enter “unknown” if you are unsure of this information.

Caseworker Email

Enter “[email protected]” if you are unsure of this information.

Funding Request Details

Enter Request Details Here:*

Please describe what you are requesting funding for. Include online payment information, if payment can be made online.

Do the items being requested need to be purchased and shipped?*

Yes
No

Shipping Address*

Where should Treehouse send the purchased item(s)?

Street Address City, State, Zip Code

Payment Details

Are you seeking reimbursement for the requested service or item(s)?*

Yes
No

Would you like your reimbursement by check or PayPal?*

Check
PayPal

For PayPal reimbursement payments:*

Please enter the name, email address, phone number or handle associated with the PayPal account.

Total Amount Paid*

Pay to:*

Who will Treehouse need to write a check to? Please make sure name is written correctly.

Mailing Address*

Where should Treehouse send this check?

Street Address City, State, Zip Code

Upload Receipt(s):*

Please provide a receipt for services or items paid. Be sure this shows the date, participant name, total amount paid, and business/vendor name.

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 100 MB, Max. files: 3.

Payment is Due By:*

Total Cost:*

Please enter the total amount that the request will cost.

Requested Treehouse Amount:*

Please enter the amount you are requesting from Treehouse.

Vendor's Name*

Please enter the full name of the vendor or business.

Hidden

Vendor's Address

Please enter the vendor's full address (Street or PO Box, City, State, and Zip Code).

Street Address City, State, Zip Code

Vendor Email or Phone Number*

Please enter the vendor’s phone number or email address.

Vendor's Website

If possible, please enter the vendor's website.

Will the payment need to be made by check or credit card?*

Check
Credit Card

For check payments: Who should the check be made payable to?*

Please enter the name of the vendor, business or person who we should make the check out to. Before making a request, please confirm with the vendor that they can accept business checks.

For check payments: Who should we mail the check to?*

First and Last Name or Business Name

For check payments: Where should we mail the check?*

Please enter the full mailing address (Street or PO Box, City, State, and Zip Code).

Street Address City, State, Zip Code

Please review and ensure that all the information above is correct*

If your request is successfully submitted you will be redirected to a confirmation page and an email with the request details will be sent to the email you provided. Eligibility must be verified before we can process a request. Once verified, you will be contacted by a Treehouse staff member to discuss your request. You will receive a response within 5-10 business days.

I HAVE REVIEWED THIS REQUEST AND CERTIFY THAT ALL INFORMATION IS CORRECT

We would love to hear from you!

Please indicate below if you are willing to receive one to two surveys over the next 6 to 12 months. Your participation helps us understand how we can better support youth experiencing foster care.

YES, SEND ME THE SURVEYS