Family Overdose Support Fund (FOSF)

Amount Requested:

What will the funds be used for?

Funeral Burial or Cremation Services

Mental Health Therapy

Childcare and Enrichment

Legal Services

Other

Check all that apply

Please provide a brief description about what the funds will be used for, including any specific services or providers:

Upload invoices for services or any documentation verifying the costs of what you are seeking the award to cover.

Drop files here or

Max. file size: 100 MB, Max. files: 10.

Awards are not guaranteed, so applicants should not purchase services with the assumption the program will pay the bill.

Does the deceased belong to a religious denomination that requires burial within a certain time frame (i.e. 24-72 hours)

Yes

Is there a planned date or preferred time for the funeral services, if so, when is it?

Name, phone number, and/or email of any funeral home, religious institution, or cremation service to be paid

Please upload any other relevant documents:

Drop files here or

Max. file size: 100 MB, Max. files: 10.

Name, phone number, and/or email of the therapist or clinical organization that needs to be paid:

Number of sessions you would like to be paid, how frequently do they occur (weekly, bi-weekly etc):

Cost per session/service:

Please upload any other relevant documents:

Drop files here or

Max. file size: 100 MB, Max. files: 10.

Name, phone number, and/or email of the youth service organization that needs to be paid:

How long will this service be accessed and how often must payments be made?

Please upload any other relevant documents:

Drop files here or

Max. file size: 100 MB, Max. files: 10.

Name, phone number, and/or email of the legal service that needs to be paid:

Please upload any other relevant documents:

Drop files here or

Max. file size: 100 MB, Max. files: 10.

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