Please complete the below application for the 2021 NCAI Fund Victim Services Micro-grant Program. Please note that this application must be completed and submitted before you navigate away from the page. A downloadable version of the application can be found here to allow you to collect all required information and documentation prior to completing the form. Submission must be made through the below webform.

If you are unable to complete this webform for any reason, please email so we can provide an alternative means of submission.