Weather Radio Campaign Application

Office Closed for Christmas: No applications will be processed after Wednesday, December 18, 2024, for the remainder of the calendar year. You can expect a staffmember to follow up with you regarding your online application by 4PM on Wednesday, January 8, 2025.
Weather Radio Campaign Application

This application is meant to help you apply for a free weather radio + batteries. It is available to the following counties: Cumberland, Fentress, Putnam, Overton, & White in Upper Cumberland, Tennessee. Keep in mind: this application is also available via paper means; if you prefer that, please call us to have it emailed or mailed to you. Throughout the year, we will also host weather radio giveaway events in our service area counties where a staff person will program your radio free of charge. You may choose to instead follow our Facebook page for updates on when we host these in-person events in your area.
Date*

MonthDayYear
Date
Please tell us your first & last name:*

First NameLast Name
Please tell us your home address (the place where you personally live and receive mail):*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the above address where you also receive packages?*

YesNo (please input the correct address above)
Please tell us your primary email (this is how we will contact you):*
example@example.com
Please tell us your primary phone number:*
Please enter a valid phone number.
How many people live in your household currently?*
Please tell us the ages of the people in your household.*
Please describe why this weather radio would benefit your household:*
Have you received a weather radio from us in the past?*

YesNoNot sure
Please upload a clear copy of your current ID. We will accept a picture as long as it is clear and shows the entire document. You may black out the document number and birthdate if you wish. We do not share any information. This online form is HIPPA secure.)*

Cancelof
Do you understand the following statements? (1) You must submit this application to be considered eligible. (2) We have a limited supply of weather radios each year. Submission of this application does not mean you are approved to receive a weather radio.*

I Have Read & Do Understand This.
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