FC Emergency Funds Authorization.pdf
PDF 180 KB Posted
- Attached to
- Master Agreement AZ|CTR055523
- Contract number
- CTR055523
- Issued by
- Arizona
About this file
This document is a Family Connections Emergency Funds Authorization form, designed for requesting and approving emergency financial assistance. The form appears to be used by a Department of Children's Services (DCS) and involves a Family Connections (FC) team, including a FC Consultant and FC Supervisor. The document provides a structured template for detailing emergency funding needs, with sections for agency information, case person details, and specific emergency fund requirements.
The form is structured to capture critical information about emergency funding, including itemized emergency funds needed, with columns for listing specific items, their associated amounts, and justification for the need. A "Total Amount" row is included to sum the emergency funds requested. The document is meant to track and authorize emergency financial support, likely for child welfare or family support services, with spaces for approvals from a DCS Specialist and tracking by the Family Connections team.
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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 .