Refugee Fund Application
Please fill this form, and we will start looking for a sponsor for your child.
Parent's First and Last Name
Child's Name and Age
Second Child's Name and Age (if applicable)
Third Child's Name and Age (if applicable)
Fourth Child's Name and Age (if applicable)
Current Home Address
Email
Phone Number
When did you come to the USA?
Are you a single parent?
Yes
Yes, and grieving the loss of the spouse in the war
No, I am married and my spouse moved here with me
No, but my spouse stayed in our country
No, but my spouse stayed in our country and is fighting on the frontline
No, but my spouse stayed in our country to provide humanitarian aid
No, but my spouse has a disability
Other (please specify below)
Do you (or your spouse if applicable) have work authorization?
Yes, both my spouse (if applicable) and I have work authorization
No, I (or we, if applicable) do not have work authorization
One of us has work authorization, another one is waiting to receive it soon
Other (please specify below)
Are you or your spouse (if applicable) currently employed?
Yes, both my spouse (if applicable) and I have jobs
No, I (or we, if applicable) do not have a job
One of us has a job, another one is hoping to find one soon
Other (please specify below)
Do you have any additional circumstances that increase your need for childcare services?
No
Yes, my child has a disability and needs special early intervention services
Yes, I have a disability and need help taking care of my child(ren)
Yes, my child is dealing with PTSD/loss/depression and needs help getting over it
Yes, I am dealing with PTSD/loss/depression and need helping dealing with it
Yes, I am taking care of a disabled family member
Other (please specify below)
Is there anything else you would like to share with the potential sponsors or any previous answers you would like to specify?
Would you like to share your child's photo?
Select a File
Would you like to share your second child's photo? (if applicable)
Select a File
Would you like to share your third child's photo? (if applicable)
Select a File
Would you like to share your fourth child's photo? (if applicable)
Select a File
While not at all a requirement, would you like us to share your child's photo/first name/family situation on our website (www.akecenter.org) to increase the chance of finding the sponsor? We will not share the last name or any contact information.
Yes, please feel free to share
No, please do not share
I forever discharge Ann’s Kids Educational Center, all its affiliates, supporters, directors, employees, of and from any and all actions, reckonings, liabilities, claims and demands arising out of, caused by or relating in any way to the donation
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