Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Plainview Disaster Relief Fund Application

  1. Plainview Disaster Relief Fund Application

  2. The Plainview Disaster Relief Fund is established to support community needs in response to COVID-19 Public Health Disaster. This fund will provide support for individuals and families who need access to food, emergency rental or utility assistance and/or support for local nonprofit organizations and local small businesses.

  3. Office Use Only:

    Received: _________________________ Reviewed: ________________________ Approved: _________________________

  4. *Please complete the following information below if applicable.*

  5. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. By signing below, applicant understands that this is only an application and there is no guarantee of funding made.

  6. Leave This Blank:

  7. This field is not part of the form submission.