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Birthparent Services

Financial Assistance Questionnaire

Financial Assistance Questionnaire

TO BE CONSIDERED FOR A GRANT, PLEASE FIRST COMPLETE THE CASE MANAGEMENT APPLICATION AND SPEAK WITH A CASE MANAGER

Grant Assistance Overview

At Shared Journeys, our mission is to honor the choice of birthparents to place their child for adoption, educate others about the challenges birthparents face, and empower birthparents by connecting them with resources, services, and community.

Through our grant assistance program, we provide financial assistance to birthparents who are working toward stability, healing, and personal growth. Grants are awarded on a responsive basis and are intended to support birthparents who are actively engaged in our services and committed to moving forward in their goals.

Types of Grants

Shared Journeys offers financial assistance in the following primary categories:

Educational/Vocational Grants
Support for educational or job training programs that help birthparents build long-term financial stability. Funds may be used for tuition, training programs, books, laptops, uniforms, transportation, and other education-related expenses.

Adoption-Competent Counseling/Therapy Grants
Financial assistance to access therapy with adoption-competent providers when insurance coverage is limited or unavailable. Counseling support is intended to help birthparents process their adoption experience and continue their personal growth.

Transportation Grants
Support to help birthparents cover transportation costs related to visits with their placed child, including gas, public transportation, or other travel expenses that make visits possible.

In addition to these core grants, Shared Journeys may also provide support for:

  • Birthparent Retreats
  • Holiday Assistance 
  • Birthparents Create! Art Grants

Eligibility

Grant applicants must be actively engaged in Shared Journeys Case Management services and demonstrate financial need. Applicants are expected to work with their Case Manager to identify goals, develop a plan toward stability or personal growth, and provide documentation related to their request.

Grant recipients are also expected to maintain communication with their Case Manager and provide updates on their progress so that Shared Journeys can track the outcomes and impact of its grant program.

Before You Apply

Before completing this form, please ensure that you:

  • Are currently participating in Case Management services
  • Have discussed your request with your Case Manager
  • Are able to provide documentation related to your financial need and request

Submitting a grant request does not guarantee funding, but each application is carefully reviewed by our Case Management team.

Thank you for sharing this information with us. We know it can take vulnerability to ask for support. Your responses will help our Case Management team review your request and determine how we can best assist you. We are honored to walk alongside you and support your continued growth and stability.

If you are requesting Emergency Assistance funding, please contact a Case Manager before submitting this form. They will review your situation, help explore available community resources, and determine whether an emergency grant request is appropriate.

Financial Assistance Questionnaire
What type of grant are you applying for?
First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Have you applied for this grant before?
Are you currently workign with a Shared Journeys case manager?
How did you hear about this grant opportunity?

Background Information

This information is collected for grant reporting purposes only, is kept confidential and has no affect your eligibility.

Race/Ethnicity (please check all that apply):
How many years of school have you completed?
Marital Status
Are you currently receiving any government assistance? (examples: Medicaid, SNAP, housing assistance, disability, WIC)

Financial Snapshot

The following questions help us better understand your current financial situation. 

What is your current employment status?
What is your approximate monthly household income?
What sources of income do you currently receive? (Check all that apply)
What are your primary monthly expenses? (Check all that apply)
Are you currently experiencing financial hardship related to any of the following? (Check all that apply)
Are you currently receiving support from other community resources or assistance programs?

Educational/Vocational Grant

Complete this section only if you are applying for an Educational/Vocational Grant. (Continue scrolling for Counseling/Therapy or Transportation Grants)

Enrollment status:
What specific cost are you requesting assistance with?
Have you applied for other financial aid, scholarships, or assistance?

Adoption-Competent Counseling / Therapy Grant

Complete this section only if applying for a Counseling / Therapy grant. (Continue scrolling for Transportation Grant)

 

Are you currently seeing a therapist or counselor?
If not currently in therapy, do you have a therapist in mind?
Does your insurance cover any portion of therapy costs?

Transportation Grant

Complete this section only if applying for a Transportation grant. 

How far do you typically travel for visits?
How often do visits occur?
What type of transportation do you use for visits?
What transportation costs are you requesting support for? (Check all that apply)
Have you explored other options for transportation support (agency support, community programs, etc.)?
Are these visits part of your adoption agreement or arranged informally with the adoptive family?

Personal Goals

Release of Information

This release does three basic things: it gives us permission to contact your agency, whom we depend on for referrals; it allows us to use your non-identifying information in our statistical analysis to evaluate the effectiveness of our services and to obtain funding from donors; and it enables us to collaborate as a team to provide the best services to you. If a grant is awarded, it also enables us to communicate with the school, therapist or property manager in order to execute payment of the grant.

I, name entered below, give permission to Shared Journeys Birthparent Collective to exchange or release information regarding adoption services. I also give permission for Shared Journeys Birthparent Collective to contact references and the adoption agency and/or adoption attorney that provided services during pregnancy and placement.

I am aware that Shared Journeys Birthparent Collective uses the information gathered for the purposes of improving services, developing new programs and securing funding and that some of the information provided above may be used for these purposes. I am also aware that Shared Journeys Birthparent Collective may use parts of my story in printed materials and/or website/social media pages. I understand that Shared Journeys Birthparent Collective will never share confidential or identifying information about me such as photos, names or contact information without my express, written consent and that Shared Journeys Birthparent Collective will seek my permission prior to sharing anything related to my story. 

If I am awarded a grant, I give permission to Shared Journeys to contact the appropriate entities in order to execute the grant (property agents/landlords, university registrar offices, therapists, etc). and that funds will only be paid directly to those entities. Shared Journeys will never disburse funds directly to a grantee for any purpose.  I also understand that failure to adhere to the terms of the grant may result in forfeiture of payments or future grants.

I am aware that Shared Journeys Birthparent Collective uses the information gathered for the purposes of improving services, developing new programs and securing funding and that some of the information provided above may be used for these purposes. I am also aware that Shared Journeys Birthparent Collective may use parts of my story in printed materials and/or website/social media pages. I understand that Shared Journeys Birthparent Collective will never share confidential or identifying information about me such as photos, names or contact information without my express, written consent and that Shared Journeys Birthparent Collective will seek my permission prior to sharing anything related to my story. 

By signing this release, I understand this allows all pertinent Shared Journeys Birthparent Collective personnel/staff to collaborate on my behalf as a team, to provide the best services deserved to me.

Consent and Release of Information. Check all the boxes that apply, to indicate your permission:
First Name *
Last Name *
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