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Financial Assistance – WILD at The Preserve
Apply for Financial Assistance for the WATP program
TEXAS THISTLE
Cirsium texensis
Financial Assistance Application
Contact Information
Name
(Required)
First
Last
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
(Required)
Email
(Required)
Voluntary Learner Identification
Demographics of the learner, not the caregiver.
Gender
Male
Female
I do not wish to disclose
Race/Ethnicity
Hispanic
Latino
Indigenous/Native American
Native Alaskan
Native Hawaiian/Pacific Islander
Black/African American
Asian
White
Two or More Races
I do not wish to disclose
Disability Status
I have, or previously had, a disability
I do not have a disability
I do not wish to disclose
Voluntary Caregiver Identification
Demographics of the caregiver, not the learner.
Gender
Male
Female
I do not wish to disclose
Race/Ethnicity
Hispanic
Latino
Indigenous/Native American
Native Alaskan
Native Hawaiian/Pacific Islander
Black/African American
Asian
White
Two or More Races
I do not wish to disclose
Disability Status
I have, or previously had, a disability
I do not have a disability
I do not wish to disclose
Veteran Status
I am a veteran
I am a disabled veteran
I am not a veteran
I do not wish to disclose
Household Structure
Annual Household Income
(Required)
Less than $20,000
$20,000 - $35,000
$35,000 - $50,000
$50,000 - $75,000
More than $75,000
Number in Household
(Required)
Less than 3
3 - 4
5 - 6
7 - 8
More than 9
Do you now or have you in the past 3 years received government assistance?
(Required)
Yes
No
Would you be able to provide documentation of household structure upon request?
(Required)
Yes
No
Is there anything else you would like to share about you or your learner in this Financial Assistance application?
Acknowledge
(Required)
I acknowledge that submission of an application does not guarantee acceptance of the application.
Certify
(Required)
I certify that my learner is within the age range for this program. (18m-5y)
Certify
(Required)
I certify that the statements on this form are true and correct to the best of my knowledge and belief.
CAPTCHA
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