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Forms

Advocate and Grantor Forms

  • Payment Requests

    Standard Payment Request Form

    To be submitted with supporting documentation (e.g., receipts, invoices, price quotes) for each disbursement request. Make copies of the form as needed. Keep confidential as the trust account number will be on this form.

    Printable Form


    Recurring Payment Request Form

    To be submitted with supporting documentation (e.g., receipts, invoices, price quotes) to set up a disbursement that will be automatically processed each month. Make copies of the form as needed. Keep confidential as the trust account number will be on this form.

    Printable Form


    True Link Payment Request Form

    To be submitted with supporting documentation for the request. Make copies of the form as needed. Keep confidential as the trust account number will be on this form.

    Printable Form


  • Annual Account Review

    To keep CCT up-to-date on the Beneficiary’s status, contact information, benefits information, and to have a general understanding of how funds from the trust will be used.

    Fill Out and Submit Online

    Printable Form

  • Monthly Budget

    A budget worksheet to help when making decisions about how to use funds from the trust. The estimated costs for the year should be based on how long you anticipate the trust lasting.

    Fill Out and Submit Online

    Printable Form

  • Consent for Release of Information

    Submission of this form gives CCT staff permission to speak with a named individual(s) regarding the Special Needs Trust for the benefit of the named Beneficiary. This form must be completed and signed by an Advocate for the trust. Confidential financial information, including the balance of the trust account, will not be disclosed. Completion of this form does not give the individual authorization to submit Payment Request Forms for disbursements from the trust.

    Fill Out and Submit Online

    Printable Form

  • Mileage

    This should be submitted with a Payment Request Form to request mileage reimbursement for driving the Beneficiary to medical appointments and other destinations to which transportation is necessary.

    Fill Out and Submit Online

    Printable Form

  • Service Provider/Caregiver

    Service Provider/Caregiver Agreement

    This form must be completed prior to the approval of payments to an independent service provider.

    Fill Out and Submit  Online

    Printable Form

     

    Service Provider/Caregiver Timesheet

    A template that can be used by a Service Provider to invoice the Beneficiary for services rendered that are allowable by the trust. This form must be (a) completed in its entirety and signed by the Service Provider and (b) submitted alongside a completed Payment Request Form signed by the Advocate.

    Fill Out and Submit Online

    Printable Form


  • Advocate Updates

    Advocate Acceptance Form

    To be signed by the new advocate to indicate a willingness to act as an advocate on a trust account.


    Printable Form


    Advocate Resignation Form

    To be signed by an existing advocate in front of a notary to remove themselves as an advocate on a trust account


    Printable Form


  • Benefit Updates

    To notify CCT of any changes to public benefits received by the Beneficiary

    Fill Out and Submit Online

    Printable Form

  • Change of Contact Information

    To change the contact information for the Beneficiary and/or Advocate (mailing address, home phone number, business phone number, cell phone number, email address, or other changes).

    Fill Out and Submit Online

    Printable Form


  • Deposits

    First-Party Deposit Form

    Complete this form to notify CCT of direct deposits to be placed into a First-Party Pooled Special Needs Trust. Deposits cannot be credited to the Beneficiary’s sub-account without a completed form.

    Fill Out and Submit Online

    Printable Form


    Third-Party Deposit Form

    Complete this form to notify CCT of direct deposits to be placed into a Third-Party Pooled Special Needs Trust. Deposits cannot be credited to the Beneficiary’s sub-account without a completed form.

    Fill Out and Submit Online

    Printable Form


    SPPT Deposit Form


    Complete this form to notify CCT of direct deposits to be placed into a SPPT Trust. Deposits cannot be credited to the Beneficiary’s sub-account without a completed form.

    Fill Out and Submit Online

    Printable Form

  • Objectives of the Trust

    Submit this form to share the goals for the beneficiary’s trust, how long the trust is anticipated to last, and the vision for how the trust should be used.

    Fill Out and Submit Online

    Printable Form


  • Statement Options

    Submit to change how financial information about the trust account is received and accessed by the Advocate.

    Fill Out and Submit Online

    Printable Form

All online forms may be submitted online or via email. If you prefer to mail in a physical copy, forms can also be printed from the Printable Form link and sent to our mailing address:


Commonwealth Community Trust

PO Box 29408

Richmond, VA 23242–0408


Documents are offered as a fillable PDF. If you wish to fill out the form using a computer, you must first save the form to your computer (e.g., Desktop) and then open it in Adobe Reader. (If needed, download Adobe Reader here.) All fields can then be completed on your computer and the document can be saved then sent back via email or mail.

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