FC Emergency Funds Authorization.pdf
PDF 180 KB Posted
- Attached to
- Master Agreement AZ|CTR055538
- Contract number
- CTR055538
- Issued by
- Arizona
About this file
This document is a Family Connections Emergency Funds Authorization form, designed for a Department of Children's Services (DCS) agency to request and approve emergency financial assistance. The form provides a structured template for documenting the specific emergency funding needs, including spaces for agency details, case information, and team contact information.
The form is set up to itemize emergency funds with columns for listing specific items, corresponding amounts, and justifications for the need. A "Total Amount" row allows for calculating the cumulative emergency funds requested. The document requires approval from a DCS Specialist and includes sections for a Family Connections (FC) Consultant and Supervisor to provide oversight and contact information. While no specific amounts or details are filled in on this blank form, it represents a standardized process for requesting and documenting emergency financial support within a child welfare context.
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Text version
Family Connections
EMERGENCY FUNDS AUTHORIZATION
Agency:
Date of Request:
Case Person:
Person ID:
DCS Specialist:
Approval Date: Time:
EMERGENCY FUNDS NEEDED:
Item Amount Justification of Need
Total Amount
TEAM
FC Consultant: Phone:
FC Supervisor: Phone:
File details come from the government source that posted it. Updated .