Comstock Reimbursement Form

Please review updated Respite Grant Guidelines before filling out this form. You can request one (1) reimbursement per grant. If you have any questions, please contact

20 Max Characters

Please use keyboard CTRL + mouse button to select all options that apply.

If you did not use grant for respite care, please enter N/A

AFTD cannot reimburse expenses incurred before the date a grant was awarded.

Please estimate the total number of hours of respite care or other services this grant provided you. If you did not use the grant for respite or other services enter 0 (zero).

AFTD can only reimburse up to $500 of your total expenses. If you have already requested a reimbursement AFTD can only pay up to the balance remaining on your grant.

AFTD is a non-profit, 501(c)(3), charitable organization. A copy of AFTD’s official registration and financial information may be obtained from the PA Department of State by calling toll free within Pennsylvania,1-800-732-0999. Registration does not imply endorsement.