Benefactor Signup Form

First Name*

Last Name*

Address

City

State

ZIP

Area Code

Phone#

Beneficiary to benefit*

Relationship to benefactor

Select the allowable expenses

Child Care: Day care, kindergarten, elementary school, high school for beneficiary's children
Clothing: Note that job-related clothing is under the "Work Resources" expense type.
Court Ordered Payments: Restitution and such fees. Note that such payments may not be legally mandated since the Minitrust funds do not belong to the beneficiary.
Documentation Support: Obtaining a driver’s license, birth certificate, Social Security card, etc.
Food: Grocery store but not restaurant, convenience store, nor alcohol
Housing: Apartment rent, mortgage payment
Medical: Medical services, medications
Transportation: Bus pass, car payments, Uber/Lyft rides
Treatment Programs: Substance abuse, anger management, basic financial management, etc, as well as individual counseling by a licensed practitioner

Funds Objective

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Use this form to enter your particulars and the restrictions you wish for this account.