Project Lead Kindly - Award Application for Kids
Thank you for applying for a Project Lead Kindly Award for KIDS. This form is for children (8-17 years old) who are applying for an award. Please be sure to read all requirements and information in regards to "Lead Kindly Awards" here: http://www.projectleadkindly.com/p/awardsprogram.html

Requirements for Children Who Are Applying:
-children must be a client serviced/housed through one of our partner agencies (http://www.projectleadkindly.com/p/partner-agencies.html)
-must be 8-17 years old
-must demonstrate trying to take purposeful steps towards a more stable life
-must give thought to how he/she has "lead kindly" in the past and how he/she can "lead kindly" in the future
-must have an advocate/case manager from a shelter or other agency, in which they are receiving assistance or other resources from, that we can contact.
-must not have used drugs/alcohol in the past 6 months.

IMPORTANT: Filling out an application does not guarantee that applicant will receive a Lead Kindly Award. Grants are awarded to applicants according to a number of factors, which include, but are not limited to: the applicant's ability to demonstrate their adherence to the principles of Project Lead Kindly's mission, the meeting of application requirements, etc., and the limits of available grant funding.

All information within applications and/or interviews are confidential. If there are any questions, please email hello@projectleadkindly.com
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Today's Date: *
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BASIC INFORMATION
First Name: *
Last Name: *
Phone Number *
(###) ### - ####
Email Address:
Birthdate: *
(MM/DD/YYYY)
Age: *
What would you like to use a "Lead Kindly Award" for? *
please select all that apply.
Required
Are you currently abusing or have abused drugs/alcohol/illegal substances in the past 6 months? *
ADDRESS
Project Lead Kindly keeps all information through applications strictly confidential, yet understands the sensitive and private nature of providing residency information for clients, especially victims of domestic violence. If unable to provide address, you may simply fill in referring agency's address below and explain any other further details in the box indicated.
Street: *
Apartment Number:
City: *
State: *
Zipcode: *
Housing Status: *
If you selected "shelter," please indicate name of shelter. If you selected "transitional," please explain & indicate name of agency that assisted you, if applicable. If you selected "other" - please explain.
List family members, if any, that you are living with *
example: "mom, dad, a brother, a sister, a grandparent, etc." If none, type "N/A"
REFERRAL INFORMATION
Referral Agency: *
please indicate the agency/shelter/facility who referred you to Project Lead Kindly.
Referral Agency's Website *
if agency/facility/shelter does not have a website, type "N/A"
Referral Agency's Phone Number: *
(###) ### - ####
Name of Person Who Referred You: *
please indicate the name of the advocate/case manager from the agency/facility/shelter who referred you.
Contact # For Advocate/Case Manager: *
(###) ### - ####
Email Address of Advocate/Case Manager: *
type "N/A" if advocate does not have an email adddress.
FAMILY INFORMATION
Any siblings? If so, what are the ages: *
School: *
please tell us if you are in school (indicate grade). if not, explain.
Please list the names of shelters, facilities, agencies you and/or your family receives financial support from. *
Are your currently employed? If so, please describe. *
AWARD USE DETAILS
If wanting to use an award towards school supplies, please indicate specifically what supplies you are needing
(ie: 1 pack of pencils, a 150 page spiral notebook, backpack, etc. PLEASE NOTE: For books, please include as much detail as possible including what course the book is for, author, title, & please provide links if applicable for purchasing online. If book has to be purchased at a specific bookstore, please indicate name and address and website if applicable.)
If wanting to use an award towards a class that will help you develop a skill towards an educational/professional goal, please describe the class, where you will be taking it, and what it will teach you.
please include name of school/place where you will be taking the class, address, website if applicable, & name/contact numbers of instructors if applicable.
If wanting to use award towards school fees, please tell us the name of the school, website if applicable, and contact name/phone numbers for school staff we can contact (ie: financial aid advisor). Please also tell us what the school fee goes towards/is used for.
please be as detailed as possible
If wanting to use an award towards a college course, please tell us what course and which college
please tell us name and address of college, and website if applicable
Do any of the needs you would like to apply an award to have SPECIFIC amounts? (ie: college books = $X amount). Please specify and explain your needs and also include specific amounts if applicable) *
Please explain if any of your needs for the award have a specific deadline. *
explain if you would need award by a certain time (ie: "I need to purchase books from the school book store by this day" or "I need to pay for this college course by this date.") NOTE: PLEASE ALLOW AT LEAST 2 WEEKS BEFORE A DEADLINE.
EDUCATION
What grade are you in? *
Have you taken any English Second Language (ESL) classes? *
Required
Do you need an English translator? *
DREAMS & GOALS
Describe any educational and/or professional goals. *
What are your biggest dreams? *
What steps have you taken and/or would like to take to get closer to your goals? *
LEADING KINDLY
What are ways you have "lead kindly" despite difficult circumstances? *
Are there any ways you'd like to "lead kindly" in the future? Describe. *
Do you have any ideas on how to help women and/or children in need? *
we would like to hear any of your ideas for kindness/service (big or small)
Would you want help in carrying out one of your service ideas from above question (with assistance from Project Lead Kindly) to help other women or children in need? *
Tell us anything else about yourself, your family, or your situation that you would like us to know.
What does the Project Lead Kindly's message mean to you and how would you apply it in your life? *
our message is reminding all people that they have a light and potential within themselves to be an example, serve, make a positive difference, and "lead kindly," no matter their circumstances.
Would you be interested in hearing about and/or participating in volunteer opportunities for Project Lead Kindly to service other mothers and kids? *
AGREEMENT
I understand that by submitting an application for a "Lead Kindly Award," I certify that I have read and understand the procedure of Lead Kindly Awards at www.projectleadkindly.com/p/awardsprogram.html. I also understand that filling out this application does not guarantee that a full or partial grant will be awarded. I understand that grants are awarded to selected applicants according to a number of factors, which include, but are not limited to: the applicant's ability to demonstrate their adherence to the principles of Project Lead Kindly's mission, the meeting of application requirements, etc., and the limits of available grant funding. I understand that awards can come in a variety of forms, including but not limited to supplies bought directly by Project Lead Kindly and PLK contacting indicated third parties such as schools, colleges, etc. I understand that if selected for an award, I may be called in for an interview in regards to my application. I acknowledge that all of the information I have submitted within this application is true. If selected to be an award recipient, I understand that Project Lead Kindly will work with my case manager/advocate to discuss dispersal of award. I also agree to be contacted by Project Lead Kindly in the future after receiving my award and to provide follow-up explaining my progress as well as my experience in "leading kindly." *
SIGNATURE (please write your full name)
DATE: *
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