Louisiana District Attorneys Disaster Response Fund Application

The Louisiana District Attorneys Disaster Response Fund

Grant Application

This fund is offered by the Louisiana District Attorneys Training Foundation and is designed to provide immediate financial assistance to active LDA Training Foundation members who have experienced financial hardships as a result of a declared disaster.

Please note the amount granted to an applicant cannot exceed the available fund balance at the time of the application.

If approved for assistance, relief checks will be mailed to the mailing addresses provided by the member applicant on his/her application.

Deadline to Apply: 5:00 PM CST on Friday, October 16, 2020
A red asterisk (*) indicates a required field.
Select a Choice:*
Employee Name:*

First NameLast Name
Date of Birth*

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail:*

Confirmation Email
Have you previously completed and submitted this application?*

YesNo
The Louisiana District Attorneys Disaster Response Fund application review process could take up to 6 weeks time. Please be patient and do not submit multiple applications. Doing so only further delays your review, approval, and grant distribution timeline.
Are you a member of LDAA and in good standing with the organization?*

YesNo
The Louisiana District Attorneys Disaster Response Fund can only provide assistance to those Louisiana District Attorneys Training Foundation members who are current and in good standing with the organization. Please contact LDAA for more information about your membership status.
Manager name at office where you are employed:

First NameLast Name
Physical Address of office where you are employed:*

Street Address

Street Address Line 2

CityState

Zip Code
Length of employment at the organization:*
Physical Home Address at time of disaster:*

Street Address

Street Address Line 2

CityState

Zip Code
Parish of Residence at time of disaster:*

AcadiaAllenBeauregardCalcasieuCameronGrantJacksonJefferson DavisLincolnNatchitochesOuachitaRapidesSabineVermilionVernonWinnOther
Your primary residence that was affected by the disaster is/was:*

Owned by youRented by youLived in, but owned by someone else
Total household income level (including spouses, partners, etc.):*
Have you evacuated from your home?*

YesNo
Amount of water in home:*
If you experienced wind damage, please select ALL that apply:*

Roof damageSiding damageWindow damageNo wind damage
Estimated amount of damage from disaster event:*
Ex: $1,000
Estimated amount of immediate relief needed:*
Ex: $500
Please select ALL of the items that were damaged as a result of the disaster:

Exterior of HomeAppliances (Ex: dishwasher, washer/dryer, refrigerator, etc.)FurnitureClothingAutomobile(s)Lost ElectricityLost FoodNone of the above
Additional Comments regarding the impact, physical damage or financial need:
Please upload up to 6 pictures of your loss/damage:

Upload a File

Cancelof
Address to which the relief check should be mailed, if approved: *

Street Address

Street Address Line 2

CityState

Zip Code
I attest the information furnished above is true to the best of my knowledge. I also understand the Fund reserves the right to require and seek verification of information submitted on this application with my employer. Finally, I agree to confidentiality on the process and amounts granted to me through this employee grant process.*

YesNo
Should be Empty: