Application form

Apply

Eligibility is limited to children who are in the physical care and custody of the Massachusetts Department of Children and Families, and young adults 18 years or older who have voluntarily readmitted themselves into the care of the Massachusetts Department of Children and Families. The applicant may be required to provide proof of adjudication, or Voluntary Placement Agreement. Rise Above cannot make reimbursements of goods or services. Please note that incomplete applications will delay request processing, or may lead to a denial of request.

Provide the following information about the child:

Name:*

First Last

Preferred Name:

If different from legal name above

Date of birth:*

Youth's Pronouns:*

Specify:

Gender:*

These choices mirror state demographic collection choice and are used in an effort to compare data

Specify:

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Gender:

Race & Ethnicity:*

These choices mirror state demographic collection choice and are used in an effort to compare data

Specify:

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Ethnicity:

Hispanic or Latino
Not Hispanic or Latino

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Race:

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Unknown
Other

Current city/town of residence:*

Child’s placement type:*

DCF foster home
Kinship placement
Comprehensive foster care (CFC) home
Group home or residential program
I’m not sure
Other

Specify:

Child’s DCF social worker:

Full name:*

Phone:

Email address:

DCF Area Office*

Specify

Step 1 of 3

Apply

Provide the following information about the child:

Child’s DCF social worker:

Request Information

Other sources of funding sought

Applicant information

Statement