Foster Angels of South Texas Request Form

Welcome to the Foster Angels of South Texas (FAST) Request Form. FAST serves 19 counties in South Texas. This form is an application to provide assistance for children currently in foster care, extended foster care or recently aged out young adults age 18-25. Once you submit this form, your application will be reviewed by one of our program staff within 48 business hours letting you know the status of the request and/or any additional questions we might have regarding your request.

Who is filling out this request?*
Are you filling out this request for a child in Laredo OR the Rio Grande Valley?*
- Yes
- No
Is this request related to delayed government benefits due to the federal shutdown?*
- Yes
- No
Is this child or youth in the Heart Gallery of South Texas?*
- Yes
- No
Caseworker Name*
First Last
Caseworker Email Address*
Caseworker Mailing Address*
Please enter your physical mailing address
Liason Name*
First Last
Liason Email*
CASA Name*
First Last
CASA Email*
CASA Supervisor’s Name
First Last
CASA Supervisor’s Email
Case Manager Name*
First Last
Case Manager Email*
Foster Parent Name*
First Last
Foster Parent Email*
Your Name*
First Last
Your Email*
Your Name*
First Last
Your Email*
Your Phone Number
Name of CPS Caseworker*
First Last
Who is your most recent caseworker with CPS?*
First Last
Caseworker Phone #
for youth form
Date of Birth
MM slash DD slash YYYY
What is your relation to the child/youth you are requesting for?*
Name of Your School*
Name of your Facility*
Child/Youth’s CPS Caseworker's Name*
First Last
What is your CPS Caseworker’s Name?
First Last
Note: Request approval pending caseworker confirmation
Director's Name*
First Last
Supervisor's Name*
First Last
Supervisor's Email*
Director's Email*
# of children/youth you are requesting for*
First and Last names of each child/youth you are requesting for*
First Last
Child's age
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Case ID #*
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
First and Last names or initials of each child/youth you are requesting for*
First Last
Child's age*
Child's Race/Ethnicity (Check all that apply)*
- Caucasian
- African American
- Native American
- Asian
- Hispanic
- Prefer not to answer
Legal county of child*
Current Placement County*
Does Region 11 have conservatorship?*
- Yes
- No
Type of Placement*
Stage of Service*
What kind of placement are you living in?*
If other, please specify
What do you need and why?*
Have you received assistance from Foster Angels this year?*
- Yes
- No
If Yes, please describe your past experience with Foster Angels in as much detail as possible.*
If other please specify
Give the background of the case in 3-5 sentences. Describe what is needed and why.*
Has this child received Foster Angels assistance during the last calendar year?*
- Yes
- No
(This does NOT disqualify the request for approval)
Is this court ordered?*
- Yes
- No
Amount Requesting*
Requesting for Store/Pay to the order of*
Please note: We do not write reimbursement checks
Would you like the item(s) in this request to be shipped to the client if we are able?
- Yes
- No
If yes, please provide link(s) to specific items. Note* we do not ship gift cards to clients
Client Shipping Name
First Last
Client Shipping Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone # for Shipping
Anything else you would like to say about this request?

Foster Angels of South Texas Request Form

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