Application Form

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The Fleetwood Memorial Foundation Fund is part of the North Texas Community Foundation and was established to provide grants for financial assistance to Certified Texas Peace Officers and Fire Protection Personnel who sustain an injury in the line of duty. Assistance grants are also considered for the family of any Certified Texas Peace Officer or Fire Protection Personnel whose death or permanent disability is line of duty related. This request for financial assistance will be reviewed by members of the Community Foundation, based on information on this form and on independent inquiries made by the Foundation.

All requests for assistance will be evaluated based on need and circumstances, without regard to race, color, national origin, religion or gender.

Determinations for financial assistance are made by members of the Community Foundation after reviewing submitted applications and independent inquiries made by the Foundation.

PLEASE RESPOND TO ALL APPLICABLE QUESTIONS