Assistance Request

*** Please note that New/Emergency placements are given priority over recurring requests, otherwise they will be filled in the order they are received. If you have any questions about the request form, please feel free to email us at hello@justonenc.org.

ELIGIBILITY & VERIFICATION
All cases and placements will be verified with the local DHHS and/or foster care agency.
1) Licensed Foster Parents with an Active Placement may submit requests for ALL children in the home under 18 years of age (including bio, adopted, guardianship)
2) Kinship Caregivers caring for a child with an Active DHHS CPS case may submit a request for ALL children/dependents who are in their direct legal care under 18 years of age. Caregivers must reside in Brunswick County.
3) Caregivers caring for a child who has been adopted or assigned guardianship from a DHHS foster care case in the last 6 months. Caregivers must reside in Brunswick County.
4) Biological Parents/Legal Guardians receiving CPS In-Home services OR who recently reunified, and case was closed in the last 6 months, resigning in Brunswick County.
5) Aged out youth who have aged out in the last 6 months or currently enrolled in the 18-21 LINKS program, residing in Brunswick County.

SERVICE AREA: BRUNSWICK COUNTY

PLEASE ALLOW MINIMUM 72 HOURS FOR REQUEST FULLFILLMENT
You can expect to receive receipt confirmation of your request within 48 hours with any questions we may have and an expected fulfillment time frame. Please remember that we are a 100% volunteer ran organization, so we appreciate your patience.

URGENT REQUESTS
If your request is urgent and you need supplies prior to or as soon as you take placement of the child please complete the form then email us at hello@justonenc.org. Attaching your placement letter from DHHS or foster care license will help expedite your request

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Does the youth you are requesting assistance for have an active Child Protective Custody, Foster Care or In-Home Service case with the local Department of Human and Health Services in Southeastern North Carolina? *

• Yes
• No
• Case has recently been closed in the last 6 months (verification still required)
• Youth has recently aged out in the last 6 months and/or is enrolled in the local LINKS program
• Other:

Please indicate if answer is "Other"

Requestors & Caregivers Information

A Requestor can be a caregiver, social worker, GAL, or other agency worker that assist our foster care caregivers. Caregivers are the families currently caring for the child whether it be a foster family, kinship caregiver, or biological parent. We must be able to verify with the local DHHS or Licensing Foster Care Agency that you currently have custody of the child with an active case or the child will be moving to your care in the near future. This includes children returning home to their parents.

Requestors Name *

First

Last

Requestors Email *

Requestors Phone

Best Way to Contact You *EmailPhoneText

Requestors Foster Care Affiliation *

• Caregiver (Foster, Kinship, Biological, Guardian)
• Child’s Guardian Ad Litem
• Caregiver’s Licensing Worker
• Child’s Agency/CPS Social Worker
• Other:

Please indicate if answer is "Other"

Caregivers Name (If you are the social worker or GAL, please provide caregivers name) *

Caregivers Phone/Email (If requestor is not the caregiver)

Caregivers Agency Affiliation (the foster families' licensing agency) or the Child's placing agency (for kindship/biological caregivers) *

• NHC DSS
• Brunswick DSS
• Pender DSS
• Onslow DSS
• ACI
• Bair
• Thompson (formerly Touchstone Residential)
• Boys & Girls Home
• Easter Seals UCP
• Children’s Home Society
• Other:

Please indicate if answer is "Other"

Caregiver's County of Residence *must reside in Brunswick County *

• Brunswick
• Other:

Please indicate if answer is "Other"

Eligible Caregivers:
1) Licensed Foster Parents with an Active Placement
2) Kinship Caregivers caring for a child with an Active DHHS CPS case
3) Caregivers caring for a child who has been adopted or appointed guardianship from a DHHS foster care case in the last 6 months
4) Biological Parents/Legal Guardians receiving CPS In-Home services OR who recently reunified, and case was closed in the last 6 months

How is the caregiver involved in foster care? *

• Licensed Foster Parent
• Kinship Caregiver
• Biological Parent/Legal Guardian
• Court Appointed Guardian
• Adoptive Parent
• Other:

What type of assistance is being requested. Check box and describe below.

• Home Repairs
• Furniture Items
• Essential Items clothing, bedding, childcare items, etc.
• Financial assistance
• Counsel/Support
• Food
• Other

Submit