Resources for Help (up to 18) – Form – Children's Foundation Of Las Vegas

Unmet Needs/Tutoring Programs (Ages 0 to 17)

Are you requesting tutoring?

Yes

Which location is most convenient for you?

Tutoring Club of Centennial/Providence • 6710 North Hualapai Way, Suite 145 • Las Vegas Nevada 89149

Tutoring Club of North Las Vegas • 6120 North Decatur Blvd, #102 • North Las Vegas Nevada 89031

Tutoring Club of Rhodes Ranch/Mountain's Edge • 7315 South Rainbow Blvd, Suite 120 • Las Vegas Nevada 89113

Tutoring Club of Henderson/Green Valley • 2213 North Green Valley Parkway • Henderson Nevada 89014

Tutoring Club of Anthem • 11241 • South Eastern Avenue • Henderson Nevada 89052

Special Accommodations?

IEP

504 Accommodations

Other

None

If "Other", please elaborate

Date of Request

Request Date Deadline

Amount of Request

Youth's First Name

Youth's Last Name

Child Identification/Unity Number

Youth's Age

Youth's Gender

Person Requesting Funds

Person Requesting Funds Phone Number

Relationship to Youth

Caregiver/Foster Person First Name

Caregiver/Foster Person Last Name

Caregiver/Foster Person Email

Caregiver/Foster Person Phone Number

Case Manager Name First Name

Case Manager Name Last Name

Case Manger Email

Case Manger Phone Number

Please select a request field

Sports- Football, Baseball, Swimming, Matinal Arts, Soccer, Basketball, etc. Helmets,

Specility Camps-Summer Camps, STEM Camps, Winter Camps

Lessons- Art, Music, Dance, Gymnastics, Horseback Riding

School Activities -Prom, Sports Uniform/Gear, School and Leadership Trips

Travel Flight Assistance for reunification with family out-of-state

Medical and Dental (Not Provided by Medicaid) - Braces, Walking Devices, Helmets

Driving lessons and car to obtain license (driving permit required)

Tutoring

Other

Request Description

Venue Contact Person First Name

Venue Contact Person Last Name

Venue Phone Number

If approved, makes checks payable to:

Program Venue Address

Address Line 1

Address Line 2

City

State

Zip Code

Program Venue Email

You MUST upload Proof of Cost/Invoice of Activity. NOTE - we cannot process request without the Proof of Cost/Invoice.

If you have any questions with regard to this application for, please call: 702-588-2272 or email: info@cflv.org

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Application For Unmet Needs Ages 0-17

Unmet Needs Request Form Ages 0-17

Application For Unmet Needs Ages 0-17

Unmet Needs Request Form Ages 0-17

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