Telic Cares Application

June 15, 2020

We know that life can become overwhelming. Telic Empowerment want you to know that you are not alone! Telic Cares is here to provide temporary relief in times of crisis. To be considered for temporary, financial relief, please complete this application in its entirety. At this time we are able to help with food, bills, or medical costs.

Though Telic Empowerment would like to help everyone that we come across, we are unable to do so at this time, filling out an application DOES NOT guarantee an award of assistance.  However, the more information you provide, the easier it will be for us to make our final determination.  You will receive a notification of our determination of eligibility and a request for documentation upon acceptance into the Telic Cares program.

By completing this application, you are giving your consent for Telic Empowerment and any volunteers working on their behalf to make the necessary inquires to confirm eligibility and validate the information provided.  All of your identifying information will remain confidential and be safely secured. Only demographic information will be used for the purposes of securing additional funding for Telic Empowerment’s programs and services.

Contact Information

Address Line 1  *
Address Line 2
City  *
State or Region  *
Country  *
Zip  *

Demographic Information

This information will not be used to determine your eligibility. It is used to help Telic Empowerment receive funds and will not be released with any identifying information.

Household Information

Income Information

Include SSI, Medicaid, SNAP, etc

Need

Submitting this application does not guarantee that you will receive funds from Telic Empowerment. We will use this information to determine if our available funds are able to meet your need. You will receive an automated email ensuring that we have received your application. Once your application has been reviewed and we have selected those who will receive assistance we will contact you to let you know our decision.