Concrete Resources Service Referral application

NOTICE:
Self-Referrals are NOT accepted.
Please see below for guidelines.

The purpose of the Concrete Resources program is to strengthen the local community by distributing funds to benefit families and their children in Arizona. Low-income families in Arizona have struggled during the COVID-19 pandemic due to illness, social isolation, job loss and lack of resources. Concrete Resources will help meet the needs of families in attaining job certifications, completing vocational programs, assisting with auto repair costs, covering dental costs, and receiving mental health support services.

The Office of Prevention will review, verify and ensure qualifying participants who are to receive funds:

  1. Are parents with children who have never been involved or have a closed report/case with the DCS or Tribal Child Protection Agency.
  2. Include sufficient supporting documentation of the vendor to be paid such as an invoice, and/or formal estimate for service. Vendor must be able to provide a W9.
  3. Are uninsured or underinsured for pediatric dentistry or mental health care
  4. Are referred by an agency representative from a Family Resource Center that participates in the program.

Agency Representative's, please complete this form in it’s entirety and provide all supporting documents (invoice/estimate) to [email protected].

Application

Participant Information Required Below

Please provide the Documents and Estimated Amount for your request:

By applying for assistance, I understand that:

  • Payment will not go to me, but will be paid directly to the company I am requesting above.
  • Assistance funds will not exceed a sum total of $1000.00
  • I am prepared to provide a formal estimate, bill or other documentation as requested.

I consent to permit the Approved Contractor and the Arizona Department of Child Safety to share information regarding my family composition, invoices, household income, assets and any other information deemed necessary to determine my eligibility for assistance.

By typing in your (participant) First and Last Name below, it will be accepted as your acknowledgement and agreement to the above statements and considered your electronic signature:

The application will be considered finalized once you click the "Submit" button.