Apply for Assistance

The goal of the Team BCI Charitable Relief Fund is to assist individuals and families impacted by natural disasters, medical ailments, and other unforeseen setbacks which cause financial strain. We specifically help BCI employees, partners, those connected to BCI, and the Houston community. 

Please fill out the below application if you believe you fit the above criteria. Our team will contact you to confirm the information. 

Date of Incident *
Date of Incident
Name *
Name
Name of BCI Employee Who Referred You to Apply *
Name of BCI Employee Who Referred You to Apply
Your Address *
Your Address
What Are Your Family’s Most Immediate Needs? *
Check all that apply:
Do You Have Any of the Following Forms of Insurance? *
Check all that apply: