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Community Support

Assistance Request Form

The journey to mental health is a challenging road for patients and their supporting families alike. The weight of this journey should not be endured alone. Like a dragonfly’s flight is light and adaptable, the mission and vision of the CJK Foundation is to alleviate the burden and offer support to those in need. The Foundation is a not for profit organization built to create positive change and hope in the darkest of times through advocating awareness, supporting patients and their families undergoing treatment and raising funds for research.
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Please fill in all sections, if the requestor and beneficiary information are the same, write same in the name box under beneficiary. Please mail or email your request to the board of CJKF. Our mailing address is CJK Foundation P.O. Box #242 Cheshire, CT 06410, or email krissy@cjk-foundation.org  please address to CJKF Donation Requests. Any questions can be directed to krissy@cjk-foundation.org or 203-376-3984. All information will be kept confidential and will only be used in determining whether the foundation can honor your request.  All applications are reivewed by the CJK Board.

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If you are in crisis or if this is an emergency, please call 911 or 988 (Suicide and Crisis Lifeline) for immediate assistance. CJK is not a crisis response organization, and this application will not receive an immediate response. CJK disclaims any and all liability of any nature for any action, or non-action, taken as a result of the information generated by this application. We do not assume any legal obligation to follow up with applicants.

Assistance Request Form

Requestor Information:

Beneficiary Information: (If different than requestor)

Has the CJKF provided any support to the beneficiary in the past?
Does the beneficiary have medical insurance?
Is the beneficiary receiving any additional financial support from other organizations, family, or friends?
Are you actively seeking support or help in other forms? (Eg: Talk Therapy)
Is your therapy court ordered? (A Yes answer does not disqualify you from receiving assistance)

Applications are reviewed by the CJK Team and overdue payments are generally not considered. Submission of an application in no way implies a commitment of funding from CJK and is not a guarantee of application acceptance for the full or partial amounts. Applications are reviewed on a rolling basis with no specific timeline guaranteed for consideration.

Thank you for reaching out! A member of the CJK team will be in touch.

Mental Health 1st Aid Sponsorship Form

Mental Health First Aid - Sponsorship Form

Thank you for reaching out! A member of the CJK team will be in touch.

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