apply online today

Applying for support is easy

Our goal is to serve you and help with your financial needs. Please use the online form below to get started.

ECAF Apply Online

What type of assistance?

Personal

Organization

Person Completing Form(Required)

First Last

Relationship to Applicant(Required)

Date of Application

Applicant Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date of Birth(Required)

Age(Required)

School Attending(Required)

Medical Condition and/or Disability(Required)

Please include letter of medical condition or disability from medical professional

Email(Required)

Parent/Guardian Information

Name(Required)

First Last

Relationship to Applicant(Required)

Please Describe:

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Present Occupation(Required)

Occupation Start Date(Required)

Preferred Phone Number(Required)

Mobile

Landline

Mobile Phone Number

Landline Phone Number

Email(Required)

Net Worth Worksheet

Assets

Personal Possessions(Required)

Car(s)(Required)

Home Value(Required)

Savings & Investments(Required)

Life Insurance (cash value)(Required)

Stocks/Bonds/Mutual Funds/CDs (Total Value)(Required)

Retirement Savings 401K's, IRA's (Total Value)(Required)

Total Assets

Liabilities

Home Loan(Required)

Car Loan(s)(Required)

Credit Card Debt(Required)

Personal Loans(Required)

Unpaid Bills(Required)

Other Debts(Required)

Investment Debts(Required)

Business Loan(Required)

Investment Loan(Required)

Total Liabilities

Total Net Worth

Assets Minus Liabilities

Financial Assistance Request Information

Purpose or requesting financial assistance.(Required)

What is the total amount of assistance you are requesting?(Required)

Assistance Documents(Required)

Max. file size: 500 MB.

Retirement Savings 401K's, IRA's (Total Value)(Required)

Who is your primary health insurance provider?(Required)

Please be specific.

Who is your secondary health insurance provider?(Required)

If applicable.

Do you have any additional sources of financial assistance?(Required)

Example: Labor Unions, Social Clubs, etc.

Please Provide Required Documents

Elmhurst Residency or Employment(Required)

Max. file size: 500 MB.

Please upload your proof of residency and employment in Emlhurst.

Tax Forms(Required)

Max. file size: 500 MB.

Please upload your most recent tax form or W-2 form.

Medical Recommendation(Required)

Max. file size: 500 MB.

Please upload a letter from a medical professional confirming the medical diagnosis of applicant.

How Did You Learn About Elmhurst Children's Assistance Foundation?

Source(Required)

Please Describe

Review

PLEASE NOTE: Any bills submitted must list the applicant and/or the applicant’s parent(s) as the responsible payer. In the event that an application is approved, ECAF may make certain payments on behalf of the applicant family but the applicant family still bears the ultimate financial responsibility. ECAF is not to be billed directly or listed as the responsible payer on any accounts.

Review Check

I certify that the information provided to the Elmhurst Children’s Assistance Foundation in this application for assistance is true. I understand that false information will negate my request for funds. I understand that the decision to grant assistance is at the sole discretion of the Board of Directors.

Confirm you are realitled(Required)

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I’m a real person

Select the ‘I’m a real person’ and complete the Google Captcha to send the form.

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apply online today

Applying for support is easy

ECAF Apply Online

Applicant Information

Parent/Guardian Information

Net Worth Worksheet

Assets

Liabilities

Total Net Worth

Financial Assistance Request Information

Please Provide Required Documents

How Did You Learn About Elmhurst Children's Assistance Foundation?

Review

Your Order