Disaster_Relief_Application

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					             The NASP Children’s Fund, Inc.

                 Disaster Relief Application




Revised: July 2011
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               Disaster Relief Application Form
Name: ________________________________________________________________

State: ________________________________________________________________

Current NASP membership? ____ Yes ____ No

Type of membership? _____ Regular _____ Student _____ Retired _____ Other

E-mail address: _____________________________ Phone: ______________________

Type of Disaster: ______Tornado ______ Flood ______ Hurricane ______

Fire _______ Other (please specify): _________________________________________

Description of Needs (please limit this to 150 words or less):




Send the completed application form to: Sally Baas (baas@csp.edu).


Please note: If you receive a Disaster Relief Grant, receipts must be received within 60 days
of your notification of the grant’s approval.




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