Treehouse - Treehouse CARES Project

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 referrals@treehouseforkids.org or 206.267.5140.

Referrals
Eligibility

Relationship Details

Relationship to Participant*

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

Other relation

Your Information

Your Name*

Please enter your name to help us process this request.

First Name Last Name

Your Date of Birth*

Please enter your date of birth.

Month

Day

Year

Your Legal Status*

Please indicate your current legal status within the foster care system. This does not impact eligibility if you already have a current Treehouse referral.

Caseworker Name*

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

Caseworker Email*

Enter “unknown” if you are unsure of this information.

Caseworker Phone Number*

Enter zeros “0000” 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 5-10 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.

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 Name Last Name

Email*

Please enter your email so that we can provide you updates on your request. You should receive a response from Treehouse staff within 5-10 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.

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 Name Last Name

Participant's Date of Birth*

Please enter the date of birth of the participant you are requesting services on behalf of.

Month

Day

Year

Participant’s Legal Status*

Please indicate the participant’s legal status within the foster care system. This does not impact eligibility if youth already has a current Treehouse referral.

Caseworker Name*

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

Caseworker Email*

Enter “unknown” if you are unsure of this information.

Caseworker Phone Number*

Enter zeros “0000” if you are unsure of this information.

Education Information

What school does the participant attend?*

Enter "N/A" if the participant is not enrolled in school.

What grade is the participant in?*

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.

Funding Request

Are you seeking funding for academic support such as tutoring, credit retrieval, school supplies, technology and equipment, graduation items, summer camp, summer school or extracurricular activities?*

Academic Support

Please select what type of academic support funding you are requesting:*

Select one.

Tutoring
Credit retrieval
School Supplies
Technology and equipment
Graduation items
Summer camp
Summer school
Extracurricular activity
Other

Please explain*

What subject area(s) does the participant need tutoring for?*

What is the reason for requesting tutoring?*

Select all that apply.

Grade improvement
Exam preparation
Subject mastery
Learning study skills
Not sure

Frequency - How often would the participant like to meet with a tutor?*

Is the participant an ESL/ELL student?*

Request Details

Enter Request Details Here:*

Please describe what you are requesting funding for. Summarize the academic need and/or tutoring services requested, if applicable. Include online payment information if payment can be made online.

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

Yes
No

Pay to:*

We can only provide reimbursements to the caregiver or Extended Foster Care participant. Who should we send a check or PayPal payment to?

Extended Foster Care Participant
Caregiver/Guardian

Total Amount Paid:*

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 name.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Payment is Due By:*

Month

Day

Year

Total Cost:*

Please enter the amount that the request will cost.

Any amount you can contribute to your request will help ensure that Treehouse can continue to serve as many people as possible.

Your Contribution:*

Please enter the amount you can contribute to the request.

Requested Treehouse Amount:*

Please enter the amount you are requesting from Treehouse.

Payment Details

Vendor Name*

Please enter the full name of the vendor or business.

Vendor's Address*

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

For PayPal reimbursement payments:

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

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?

Please enter the name of the person we should mail the check to.

First Name Last 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 Apartment City State Zip

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 more 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

Treehouse CARES Project

Tutoring, Academic Remediation and More

Funding Request Form (CARES Project)

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

Relationship Details

Your Information

Contact Information

Your Information

Participant Information

Education Information

Funding Request

Academic Support

Request Details

Payment Details