Homeschool Crisis Relief Grant Application Homeschool Crisis Relief Grant Application Recipient Information(Required) First Last Spouse Name First Last Home Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) How many children are you homeschooling?(Required)Please select an option from the drop down12345678910+How long have you been homeschooling in Colorado?(Required)Please select an option from the drop downLess than 1 year1-3 years3-5 yearsover 5 yearsCrisis InformationPlease tell us about your crisis and reason for applying for crisis relief.(Required)Were you insured?(Required)Please select an option from the drop downYesNoNot ApplicablePlease explainWill insurance cover the expenses related to your crisis?Please select an option from the drop downYesNoNot ApplicableIf granted, what will crisis relief funds be used for? (You will be required to submit copies of receipts)(Required)Amount requested(Required)Verification InformationIs there a church that you belong to or regularly attend?(Required)Please select an option from the drop downYesNoWhat is the name of your home church?(Required)Is there someone in leadership at your church that is aware of your situation that we can speak to?(Required)Please select an option from the drop downYesNoChurch Leader Name First Last Church leader email address Church leader phone numberI certify that all information provided on this application is true and accurate.(Required) The above information is true and accurate. Media Permissions Media Permissions(Required)Sharing your story or quotes with donors and ministry partners is our most effective means of communicating the importance of what we do and raising financial support to help families like yours! Would you give us permission to share your story? Please select an option from the drop downYes, using my first name and last initial (e.g. Jane D.)Yes, using my first name onlyYes, anonymouslyNo, prefer not to shareHow can we specifically be praying for you? Δ
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