Emergency Response Fund

Emergency Response Fund Application

The purpose of the Virgin Islands Good Food Emergency Response Fund is to provide farmers, fishers, ranchers, producers, and food system-related businesses in the US Virgin Islands with prompt emergency assistance and disaster relief, with priority given to individuals and businesses with immediate and urgent needs.

1. YOUR INFORMATION
1. YOUR INFORMATION
Name*

First NameLast Name
Farm/Business Name (if applicable):
Neighborhood/Estate:
Island*
Mailing Address*

Address Line 1

Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Type of Work (Check all that apply):*

FarmerFisherRancherProducerFood Related BusinessOther
Farm/Business Registration # (if applicable):
EIN # (if applicable):

2: EMERGENCY DETAILS
Type of Emergency (Check all that apply):*

Natural Disaster (Flood, Drought, Fire, Storm, Earthquake, etc.)Disease/Pest OutbreakEquipment/Infrastructure DamageFinancial Crisis due to Market DisruptionsOther
Date of Incident*

MonthDayYear
Date
Brief Description of Impact: *
(Explain how the disaster or emergency has affected your business or livelihood as an owner/operator.)

3. REQUESTED ASSISTANCE
Financial Support (Amount Requested):
$
Additional Types of Assistance Needed (Check all that apply):*

Additional Financial Support (Indicate Full Cost Below)Seeds, Fertilizers, or FeedsEquipmentLivestock/Poultry SupportInfrastructure RepairTechnical Support/TrainingVolunteer LaborOther (specify)
If you were to receive full financial support, what would be the total cost?

SUPPORTING DOCUMENTATION
Please attach copies of the following documents where applicable.

Photos of Damage, if available. Other Supporting Evidence, if available (examples: receipts, insurance claims, quotes)
Cancelof
Is there anything else you would like us to know? (Optional)

Emergency Response Fund Application