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Application for Harvey Relief Funding - Deadline 12/27/2017

In order for your community to be eligible to receive funding from LeadingAge's Disaster Relief Fund, this application must be completed & submitted by December 27, 2017.
  • NOTE: If you are applying for funding on behalf of more than one community/site, you must complete a separate application for each
Contact LeadingAge Texas at (512) 467-2242 x102
or crystal@leadingagetexas.org with any questions
1.Name of LeadingAge Texas member applying for funding(Required.)
2.Your contact information/information for the main contact at the abovementioned member(Required.)
3.If awarded Disaster Relief Funds where will you use the funds? Check all that apply.(Required.)
4.How much in Disaster Relief Funds are you requesting?(Required.)
5.If awarded, explain how the Disaster Relief Funds will be spent.(Required.)