Luke's Legacy Grant is a grant that provides funding for families and/or individuals that need extra support and services, such as home renovations to make your home more accessible, medical equipment, therapy, and travel expense reimbursements related to medical or therapy appointments. Reimbursements for medical purposes only may include, but not limited to hotel, food, therapy, etc.
Your Name
First Name
Last Name
Nominee Information
Name of Nominee
First Name
Last Name
Relationship with Nominee
Father
Mother
Guardian
Other
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth of nominee *MM/DD/YYY*
Address *Nominee must live in SWLA; Calcasieu, Allen, Jeff Davis, Cameron, Beauregard*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Proof of Residence *Utility bill within the last 3 months*
*
Browse Files
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Choose a file
If the bill is not in parent/guardian's name or if they are not the homeowner, please provide a copy of utility account holder photo ID
Cancel
of
Medical Condition
Please provide a description of condition and any information that would help with a better understanding of the need.
What challenges does the nominee struggle with daily?
Tell us about nominee's family life.
Give us a look into the family and life living with a person with needs.
Has this individual received any grants in the past?
If yes, please list any grants that were received and how the funds were used.
How would receiving Luke's Legacy Grant affect your life?
Tell how you would use the money received from Luke's Legacy Grant and what it would mean to your family.
How did you hear about Luke's Legacy Grant?
Facebook
Friend
Other
In the event of being awarded this grant, Families for Inclusion will share the recipient's name and story on social media, such as Facebook and Families for Inclusion website.
*
Yes, I give you permission to share.
No, I do not give you permission to share.
Date
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Month
-
Day
Year
Date
Signature
Submit
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