Apply for Help

How can I GET HELP?

Are you disabled and in need of help and living in Northeast Florida? Do you know of someone who is in this position? JT Townsend has pledged to give back to the community that so generously helped him when he needed help most in his life. His foundation vision is to pay it forward by reaching out to those that are in the position he found himself in in 2004.

We are here to provide for your needs. Just tell us what you have in mind by completing the form below and we will do our best to review your request efficiently to determine if we can help.

JT Townsend Foundation, Inc. affirms that it does not discriminate on the basis of ethnicity, race, gender, sexual orientation, creed, disability, philosophy, veteran status, marital status or any other basis prohibited by applicable law in either internal policies and procedures or external policies and procedures.

Please fill out the form below.

You can also print this form and submit it by email or by mail, to the addresses below.

Fax: 904.273.3999
Email: carmenjttf@gmail.com

Address:
JT Townsend Foundation
830 A1A North
Suite 13 #187
Ponte Vedra Beach, Florida 32082

Application for Assistance

Date

MM

DD

YYYY

Name

First Name

Last Name

Date of Birth

Email

Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Person Completing App. (If Different From Applicant)

Phone Number

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Relationship to Applicant

Describe the Nature of Disability

Doctor's Contact Information

How Can We Help?

How Did You Hear About JT Townsend Foundation?

If "Other", Please Explain:

By filling out this application, I the applicant, by signing below, hereby grants JT TOWNSEND FOUNDATION, INC., the right to use my name, my picture submitted, my information, and my story described herein, without compensation, in electronic form (including the JT TOWNSEND FOUNDATION, INC., website) and/or in any JT TOWNSEND FOUNDATION, INC., publication or written material. Applicant understands that JT TOWNSEND FOUNDATION, INC., will use my information, my submitted text, and my likeness only for promotional and/or educational purposes. I hereby agree to hold JT TOWNSEND FOUNDATION, INC., its licensees and affiliates harmless from any liability resulting from my statements and actions depicted or described in the information, text and graphic representations herein submitted.

By checking this box, I release my personal information to JT Townsend Foundation and understand the Information Release above

I Agree

Please forward any additional relevant documents to carmenjttf@gmail.com

How can I GET HELP?

Application for Assistance