4-H Kids Helping Kids
Name___________________________________________________________
Age _______________
Address ________________________________________________________
Parent’s Name ___________________________________________________
Request made by ________________________________________________
Amount of Request_______________________________________________
What money will be used for:
_________________________________________________________________
_________________________________________________________________
Family situation that warrants this need:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
This information is confidential and will only be used to determine
the awarding of grants.
Return this form to
White County 4-H Kids Helping Kids
% Amber Ochs
2104 Co Rd 1725E
Crossville, IL 62827
Or email to
ochsrabbits@gmail.com
aochs@carmischools.org