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Hope Fund Application

The  purpose of the Hope Fund is to help providers from CCC partner agencies access resources to help their client/families accomplish established goals.  Applications need to be submitted by staff providers and all communication is between the provider and the Hope Fund committee.  Please remember that families have a $1,000 cap in a program year (3 terms) which begins on October 1st.

  • General Information

  • At least one child must be prenatal to age 8
    age of child 1age of child 2age of child 3 

  • Request/Need Information

  • Brief family history and description of need or barrier.
  • What is the goal the family is working on?
  • Requests for services already rendered or goods already purchased will be denied.
  • Please indicate below which resources have already been considered or pursued and whether the results were "n/a," "denied," "granted in part," etc.
    General AssistanceDHHS Emergency AssistanceDowneast Community PartnersShaw FundRobbie FundFamilyOther 
  • Please categorize your request according to the following areas
  • What are the consequences for the family if this request is denied?

  • Additional Documentation

    All requests must include invoice or estimate for repair, purchase, or services. Auto repair requests must include the cost of inspection. If combining Hope Fund with other resources to complete a purchase or project, you must fill out the Combined Funding Budget form below. If request commits family to future payments (e.g., security deposit or down payment) you must fill out the Household Budget form below. Supporting medical/dental/mental health information from a health professional is required for medical requests.
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf, doc, xls, docx, xlsx, , Max. file size: 32 MB.

    • Tips for uploading documents

      If your client needs to submit a photo of a bill as part of the family's application, ask them to use the flash when taking the photo, and to email you the photo (large size is best) instead of texting you, if possible. Emailed photos are much clearer than texted photos which can be very hard to read.

    • Combined Funding Budget Form

      Use only if you are combining your request from other sources. Only fill in the line items that apply to this request/need. Total costs must equal total funding. Do not fill this out if the Hope Fund is the only funding source for the request/need. To use this form, click on the link below and download to your computer and save. Fill out the form saving your changes, and upload with any supporting documentation in the space provided above.
    • Please click to complete the combined funding budget form.

    • Monthly Household Budget Form

      Use only if the request commits family to future payments. Use figures that do not include requested support. To use this form, click on the link below and download to your computer and save. Fill out the form saving your changes, and upload with any supporting documentation in the space provided above.
    • Please click to complete the monthly household budget form.

    • Payment Information

      must be completed
    • not participating in a follow-up interview will have no impact on the funding decision. You may change your mind about participating in the follow-up interview at any time.
    • please print your name - this will be your e-signature
    • Please print your name - this will be your e-signature
    • MM slash DD slash YYYY
    • A multi-agency committee of the Community Caring Collaborative reviews applicant information. The CCC encourages providers to arrange for necessary releases of information.
    • This field is for validation purposes and should be left unchanged.
    Save and Continue Later