Request for Donation

The following is a funding request form that is used in order for us to grasp exactly what necessities must be addressed for a student. This form helps us manage what area the student will need help with and allows us to form a solution to the problem. In order to be eligible for funding from the Touch-A-Life Foundation, the receiver must be a homeless high school student, with the dreams of going to college.

Please fill in the form below and we'll get back to you at the earliest. Fields marked by an asterisk (*) are required fields.

School Contact Information
School Name * City *
State * Zip Code *
Key Contact Information
Contact Person * Designation *
Relationship with Student * Phone *
Name of the Student Upload Student's Picture
Needs and/or Conditions to be Addressed *
Include any needs and/or conditions that the student requests including,
but not limited to, food, drinks, clothing, school supplies, shoes, etc.
Information about the Student's Education *
Include the grade level, GPA, and school attendance record.
Information about Student's Housing *
Include how long the student has been homeless for and what their
current form of housing is.
Student's History *
Does the student have a prior history of crime(s) and/or drugs and alcohol?
Funds and Grants *
Is the student currently receiving any funds and/or grants from
any other organizations? Please Specify.
Duration of Funds *
Student's Current Situation and Past *
Please describe your student's current situation and any information on their family.
Also include information on struggles the student has faced in their lifetime
Captcha*


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By clicking here, you establish that all information included in this form is accurate,
      up to date, and has only been recorded by the main contact.