Member Relief Funds Application
The DFW-CHW Association can provide limited funds for members are experiencing financial hardship.

Requirements:
* Must be an active paying member of the DFW-CHW Association
* Limited to 1 application per year
* Must be able to describe financial hardship

Please note: The association can award $200 in relief funds per member annually. Funds are limited; please only apply if you are truly in need. All requests may not be approved, even though there may be a clear need for assistance. Funding is based on demonstrated need and available funds.

Members will be notified via email if funds will be awarded. Please ensure your contact information is entered correctly and in full.
Applicant Name: *
Applicant email address: *
Mailing Address (Street, City, State, Zip) *
Are you a current CHW or CHWI? *
Are you a current member of the DFW-CHW Association? *
Describe the financial hardship that is the basis for this application and how the funds will be used. *
What is your preferred method of payment? *
I certify that the information provided in the application is complete and accurate and that my financial hardship is genuine. I will apply all money received toward debts related to my hardship. Below is my online typed signature certifying this statement (please list full name). Note: This is REQUIRED in order to receive funds. *
If awarded funds, would you be willing to share your experience with the DFW-CHW Association Members (via photos, spotlight in newsletter, or during our quarterly member meeting)? Note: this is not required in order to receive funds. *
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