(Form last updated March 8, 2021; for questions about this application, please contact MOAA's Member Service Center at 800- 234-6622 or e-mail email@example.com)
Thank you for taking time to help The MOAA Foundation verify an applicant for the COVID-19 Emergency Financial Relief Grant. Please complete and submit the Council/Chapter Verification Form.
If the individual you are assisting is awarded a grant, funds will be disbursed to them pending submission of verification information requested in their award email. If they have not provided required documentation as requested within 30 days of the foundation sending their award email, their grant award offer will expire, and they will need to submit a new application for consideration.
Verification Form Option: If you would prefer to use a fillable PDF/printer-friendly version, learn more and download.
Council/Chapter Verification Form