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Hidden Heroes Caregiver Grant Application
On April 25, 2017 Alzheimer's Texas will award $1,000 each to 5 unpaid/family caregivers in the Central Texas area. Family caregivers of all chronic illnesses can be nominated to receive the grant. Please complete all of the questions below for the caregiver you would like to nominate to received the $1,000 grant. In addition to the grant money, winners will receive two free tickets to the event. Please only submit one application per person. A committee of community members will review and select the winners. Winners will be announced in March. Tickets and tables for the event can be purchased at www.txalz.org.
Email address
Your Full Name
Your answer
Your Phone Number
Your answer
Your Email
Your answer
Name of Caregiver You Are Nominating
Your answer
Nominee Phone Number
Your answer
Nominee Email
Your answer
Disease/condition of the person they care for:
Your answer
Age of the person they care for:
Your answer
How long has the caregiver provided care?
Your answer
Does the caregiver receive monetary compensation of any kind for providing care?
The person they care for lives:
Which city does the caregiver live?
Your answer
Why do you think this caregiver should receive the grant?
Your answer
How does this caregiver provide exceptional care?
Your answer
What else would you like for us to know about this caregiver?
Your answer
Additional Comments
Your answer
Caregiver's Phone Number
Your answer
Caregiver's Email
Your answer
A copy of your responses will be emailed to the address you provided.
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