Dreamers and Believers Application ย Step 1 of 5 20% Child's Full Name* First Last Child's Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What is your child's status?* Foster Care Placement Kinship Care Placement Child's ID# (see board check for ID):* DCP&P Caseworker InformationDCP&P Caseworker's Full Name* First Last DCP&P Caseworker's Phone Number (XXX)XXX-XXXX*DCP&P Caseworker's Email* DCP&P Caseworker's Office Location (e.g., Mercer North Local Office)* Caregiver's InformationCaregiver's Full Name* First Last Caregiver's Daytime Phone (XXX)XXX-XXXX*Caregiver's Email* Address* Street Address Apt. #, Suite, etc. City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I have read and understand the information and eligibility requirements for the Dreamers and Believers award process. I also give the New Jersey Division of Child Protection and Permanency (DCP&P) permission to confirm any information on this application.* Yes, I Agree Vendor / Service Provider InformationVendor / Service Provider's Name* Vendor / Service Provider's Address* Street Address Apt. #, Suite, etc. City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Vendor / Service Provider's Phone Number (XXX)XXX-XXXX*Vendor / Service Provider's Email* Vendor / Service Provider's Website (if not applicable, type NA)* Information About Your Dream: (Note: This section should be completed by the child or youth if age appropriate.)How Much Money Are You Requesting?* I will use the money for the following special activity*Describe how this award would assist you in pursuing your dream*If your award is approved, what would you like to say to the Dreams R Us Foundation and embrella for providing this opportunity*Upload documentation showing the cost of the activity (flyer, brochure, invoice) -OR- enter vendor's website on the previous page (If you haven't already).Max. file size: 50 MB.HiddenVendor's Website By checking this box, I grant embrella permission to utilize all or a portion of my or my child's comments, and/or the comments of my child in care, from this application and any thank you notes for the purpose of inclusion in embrella's marketing, information, educational, contractual, fundraising or other materials. I understand only first initials will be used. I agree How did you learn about embrella?* Internet Search (Google, etc.) Social Media (Facebook, etc.) DCP&P Friend Other (See below) Other* Yes, I'd like to receive email newsletters from embrella HiddenRecord Type Automation Captcha Δ
