Hurricane Helene Request For Financial Assistance

Application for Hurricane Helen Financial Assistance

This is a needs-based financial assistance program for property damages after Hurricane Helene.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status*
Income Revenue*
Employment Status*
Household Size*
Scope Of Repairs Needed*
Amount of Funds Requested*
Are you be willing for the church to find someone to do the work?*

YesNo
If not, please provide three bids outlining the scope of work needed and the cost for completion of the job.
Bid #1

Browse Files

Cancelof
Bid #2

Browse Files

Cancelof
Bid #3

Browse Files

Cancelof
Terms and Conditions

As a condition of receiving financial assistance, the Applicant agrees to provide supporting documentation for the work or expenses covered by the funds. This includes, but is not limited to, clear photographic evidence of the work completed and/or receipts from the completed project. You are also acknowledging that these funds will not cover the full cost of the scope of work, but it meant to provide assistance for your project.

Any future fund dispersements will be contingent on documentation of a completed project for these funds.
Signature*

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Date*

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Date
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Application for Hurricane Helen Financial Assistance