Hurricane Ida Assistance Questionnaire
Faith Formula will be offering food, clothing, and lodging reimbursement assistance to families who are currently in the Dallas service areas as a result of damages due to Hurricane Ida. We will also offer utility assistance for families who are currently housing families who have evacuated to the Dallas area. After completion of this form, a case manager will be in contact with you directly.
Name
First Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you currently in the Dallas area as a result of the damages from Hurricane Ida?
Yes
No
How many people from your household are here with you?
Please Select
1-4
5 or more
What date did you come to the Dallas area?
-
Month
-
Day
Year
Date
Have you applied for FEMA?
Yes
No
Are you receiving any assistance from Red Cross or any other agency?
Yes
No
What is your current living arrangement?
Hotel
With a relative or friend
Other
Are you in need of food?
Yes
No
Are you in need of clothing?
Yes
No
If you are housing family or friends who evacuated Louisiana as a result of Hurricane Ida, are you in need of any of the following:
Utility assistance
Food
Rent
Can you show proof of your need? (proof of increased bills between August 24th and now)
Yes
No
Submit
Should be Empty: