Fund Request Form

Request program materials, resources, or financial assistance to support youth mental health initiatives.

PUM is committed to supporting youth mental health initiatives by providing resources that help young people learn, grow, and thrive.

Applicant Information

Full Name *

Organization/School Title/Role

Phone Number Email Address

Address

City State Zip

Type of Request

Check all that apply.

Workshop MaterialsEducational ResourcesMental Health Awareness MaterialsEvent SuppliesYouth Program SupportCommunity Outreach MaterialsScholarship Assistance

Other

Description of Request

Please describe the materials, resources, or funding being requested

Amount Requested

Total Amount Requested ($) Estimated Materials Value ($)

Purpose of Request

How will these funds or materials benefit youth and support mental health education, awareness, or advocacy?

Number of Youth Impacted

1–1011–2526–5051–100100+

Estimated Number

Additional Funding Sources

Have you applied for or received funding from other sources for this request?

YesNo

Supporting Documentation

Check any documentation you can provide on request.

BudgetProgram DescriptionVendor QuoteEvent Flyer

Other

Certification

I certify that the information provided in this request is accurate and that any funds or materials received will be used solely for the purposes described above.

Signature

Applicant Signature (type full name) *

Date

💗 Perfectly Unperfect Minds® (PUM) — Youth Mental Health Education & Advocacy

"Investing in young minds today creates stronger communities tomorrow."

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