Contact CJK Foundation for Mental Health in Connecticut

Looking to volunteer, receive services, or learn more about the Foundation? Fill out the form below and a representative will be in touch.

Krissy Dorsey
203-376-3984
205 Jinny Hill Rd
Cheshire, CT 06410

Mental Health First Aid - Sponsorship Form

Donation 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.

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 205 Jinny Hill Rd Cheshire, CT 06410, or email [email protected] please address to CJKF Donation Requests. Any questions can be directed to [email protected] or 203-376-3984. All information will be kept confidential and will only be used in determining whether the foundation can honor your request.

* Indicates required field

Date of Request *

Requestor Information:

Name *

First

Last

Address *

City *

State *

Zip Code *

Email *

Phone *

Beneficiary Information: (If different than requestor)

Name *

Address *

City *

State *

Zip Code *

Email *

Phone *

Is beneficiary under 18? *

Has the CJKF provided any support to the beneficiary in the past? *

If yes please provide dates *

Description of situation *

How will the donation be used? (co-pays, med refill, other) *

Amount of donation *

Payable to *

Payee address *

Payee phone number *

Additional information or directions that CJKF may need to process your request *

Is the beneficiary receiving any additional support from other organization? *

If yes, What type and from whom? *

Submit

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Mental Health First Aid - Sponsorship Form

Donation Request Form

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