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

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* 1. Name of LeadingAge Texas member applying for funding

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* 2. Your contact information/information for the main contact at the abovementioned member

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* 3. If awarded Disaster Relief Funds where will you use the funds? Check all that apply.

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* 4. How much in Disaster Relief Funds are you requesting?

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* 5. If awarded, explain how the Disaster Relief Funds will be spent.

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