REALTORS® RELIEF FOUNDATION Application for Disaster Relief Assistance

REALTORS® RELIEF FOUNDATION Application for Disaster Relief Assistance
Type of Assistance

Assistance is available to qualified applicants towards one of the following options: 1) Monthly mortgage expense for the primary residence that was damaged by the Disaster or; 2) Rental cost due to displacement from the primary residence resulting from the Disaster or; 3) Hotel reimbursement due to displacement from the primary residence resulting from the Disaster. Relief assistance is limited to a maximum of $1,000 per household. Deadline for application submission is January 10, 2025. Please note this assistance is for housing relief only; other expenses including second mortgages (home equity lines or loans), clothing, appliances, equipment, vehicle purchase, rental or repair, and or mileage are ineligible for reimbursement under this program.

Eligibility

Recipient must be a full-time resident and U.S. citizen or legally admitted for residence in the United States. Recipient must have their primary residence in one of the 91 counties included in Governor Kemp's original disaster declaration.

Confidentiality

All information provided on this form will remain confidential and will be available only to those who need to confirm eligibility for assistance and to those who process the assistance to be provided. This includes providing a copy of this application to the applicant's lender or landlord, if requested. It will not be shared with other parties for any other purpose.

Disbursement of Funds

In order to provide for a reasonable and equitable distribution of funds, assistance will be provided on a first come, first served basis. All grants are contingent upon the availability of funds.
Attachment Checklist
Required for All Applicants
1. Photo Identification to Show Proof of Residency [i.e. driver's license or other governmental documentation evidencing residency]
2. Copy of Mortgage Statement or New Lease Agreement or Hotel Receipt.
Upload both of these required identification documents here.*

Accepted File Types: PDF, JPG, JPEG, PNG, DOC, DOCX | 10MB Max File Size
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One of the Following is Required to Show Proof of Damage to your Primary Residence:
1. Photos of Damages.
2. Insurance Estimate.
3. Copies of Written Claims, Settlement Proceeds or Claim Status Reports.
4. Copies of Repair Estimates from Contractors.
Upload one of these required proof of damage documents here.*

Accepted File Types: PDF, JPG, JPEG, PNG, DOC, DOCX | 10MB Max File Size
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*REQUIRED: GENERAL INFORMATION

Please complete all information to be considered for assistance
Full Name*

First NameLast Name
Email Address*
example@example.com
Address of Damaged Property*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Mobile Phone*
Please enter a valid phone number.
Other Phone
Please enter a valid phone number.
Type of Dwelling*
Other Dwelling Type Description*

*REQUIRED: PROPERTY INFORMATION/DESCRIPTION OF LOSS
Describe damage/loss relating to your primary residence*
Total Cost of Damage*
Total Uninsured Loss to Primary Residence*
If displaced from your primary residence, when do you expect to be able to return to your home?*

Please detail any financial assistance you have received from other sources

	Provider	Description of Assistance	Amount Received
1
2
3

*REQUIRED - Please indicate type of assistance sought.*

Mortgage Payment (primary residence)Rental Cost (temporary housing)Hotel Reimbursement (temporary housing)
Hotel Expense Reimbursement
Hotel Charge*
Amount of monthly housing obligation
Mortgage*
Rent*
Name of Lender / Mortgage Servicer*
Lender Website Address
Lender Telephone*
Please enter a valid phone number.
Mortgage Loan Account #*
Name of Landlord*
Landlord Telephone*
Please enter a valid phone number.

IMPORTANT: PLEASE COMPLETE THIS SECTION IF CURRENT MAILING ADDRESS IS DIFFERENT THAN ADDRESS PROVIDED ON PAGE 1.
Full Name

First NameLast Name
Email Address
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
DECLARATION (REQUIRED)
By signing this application, I verify that all the information presented herein is true and correct to the best of my knowledge. I agree that the lender/service provider or landlord listed above may be contacted to verify information contained in this application. I also provided all supplemental documents as required.
Printed Name of Applicant*

First NameLast Name
Signature of Applicant*

Clear
Date

MonthDayYear
Date
Questions
If you have any questions, please contact Georgia Association of REALTORS® at disasterrelief@garealtor.com.
*By submitting your information with this form you agree with the storage and handling of your data by this website as described in our Privacy Policy.
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REALTORS® RELIEF FOUNDATION Application for Disaster Relief Assistance

Attachment Checklist

*REQUIRED: GENERAL INFORMATION

*REQUIRED: PROPERTY INFORMATION/DESCRIPTION OF LOSS

IMPORTANT: PLEASE COMPLETE THIS SECTION IF CURRENT MAILING ADDRESS IS DIFFERENT THAN ADDRESS PROVIDED ON PAGE 1.

DECLARATION (REQUIRED)

Questions