AARC Disaster Relief Fund Grant Application
Complete the form below to apply for a grant from the AARC's disaster relief fund, or call (972) 406-4682 to apply over the phone.
Your Contact Information
Name
*
First Name
Last Name
AARC Member Number
*
Daytime Phone
*
Please enter a valid phone number.
Email
*
example@example.com
Address (This is the address where a check should be sent if your request is approved.)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Damage/Loss Information
When was the disaster declared that affected your area?
*
-
Month
-
Day
Year
Date
Address of Damaged Property
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: