NRC Cares Applications

First Name

Last Name

Email Address

Cell Phone Number

What type of support are you applying for?
Individual\Family SupportCommunity Support
What is the nature of the need?
Natural Disaster ReliefMedical Funding SupportCosts not covered by FMLA\PTO or inability to workLiving Expenses SupportNomination for Community SupportOther
Please provide a clear description of the specific crisis, problem or concern of which assistance is being sought.

Who and\or how many people are\will be affected by this crisis or concern?

Attach supporting documents if possible: image files accepted

By submitting this application, I acknowledge and agree to the following:
-I understand that submission of this application does not guarantee that assistance, funding, or services will be awarded, nor does it guarantee any specific timeline for review, decision, or distribution of support. All applications are evaluated on a case-by-case basis and are subject to the availability of resources.
-I acknowledge that applications are monitored on an ongoing basis for emergent or urgent needs; however, in most cases, applications are reviewed monthly by the organization’s Board of Directors to determine eligibility and awards.
-I consent to being contacted by the organization via phone, email, text message, or other reasonable methods for the purpose of reviewing my application, requesting additional information, providing updates, or offering services related to this application.
-I understand that the organization does not discriminate in its review or award decisions on the basis of age, sex, gender identity, sexual orientation, race, color, ethnicity, national origin, religion, disability, marital status, or any other characteristic protected by applicable law.
I agree