“Grant A Wish” Referral Form

“Grant a Wish” Criteria

Please review the criteria listed below before submitting a referral form.

Some things to consider when making a wish:

The “Grant a Wish” program is designed to empower and support a foster child’s self esteem through assistance with a life skill, athletic activity, or the arts. This program is intended to provide our children with the basic things needed to help them assimilate with their peer group and foster family (clothes, sports equipment, room makeover). Wishes can also assist with a special birthday party, prom expenses, graduation, summer camp or senior trip.

In cases where shipping is required, we add 10% to the cost estimate to provide for shipping.


Date: Monday, February 2, 2024 at 12:53pm

Your Name: First/Last
Your Email:
Your Phone:
Your State:
Your County:
Organization Type:
Relationship to Child:
(At present, please request that
the case worker make this request).

Social Worker Information

Worker Name: First/Last
Worker Email:
Worker Phone:
Worker State:
Worker County:
Worker Organization:
Worker Organization Type:
Youth's First/Last Names:
Youth's Birth Month/Year:
Youth's Gender:
(Example –
Art supplies, summer camp,
dance lessons, basketball hoop,
etc. Please be as descriptive
as possible. Details
help us grant the
perfect wish.):
Additional Wish Details
(Please give us more
information regarding why
this wish is being requested,
estimated price, etc.):