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 and travel expense reimbursements related to medical or therapy appointments. Reimbursements for medical purposes only may include, but not limited to hotel, food, etc.
When filling out the application, please provide as much information as possible.
Nominee Information
Name of NOMINEE
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Birthdate of NOMINEE *MM/DD/YYYY*
Relationship with NOMINEE
Father
Mother
Guardian
Self
Other
Address *Nominee must live in SWLA; Calcasieu, Allen, Jeff Davis, Cameron, Beauregard*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Condition: Please provide a description of nominee's condition and any information that would help with a better understanding of the condition.
Challenges: What daily challenges does the nominee struggle with?
Family: Tell us about nominee's family life. Explain what it is look into the family and life living with a person with needs.
Has the nominee 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 nominee's life? Explain how the reward money would be used for nominee and how it would benefit nominee’s life.
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
Submit
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