Hurricane Helene Disaster Relief Intake Form
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  • Hurricane Helene Disaster Relief Intake Form

    Apply for assistance through Lutheran Services Carolinas' Disaster Relief program. Please complete all sections to help us assess your needs.
  • Applicant Information

  • We can only serve the following counties in South Carolina: ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, CATAWBA, CHEROKEE, CHESTER, EDGEFIELD, FAIRFIELD, GREENVILLE, GREENWOOD, HAMPTON, JASPER, KERSHAW, LAURENS, LEXINGTON, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, UNION, YORK. We also serve the following counties in North Carolina: ALEXANDER, ALLEGHANY, ASHE, AVERY, BUNCOMBE, BURKE, CALDWELL, CATAWBA, CLAY, CLEVELAND, EASTERN CHEROKEE, GASTON, HAYWOOD, HENDERSON, JACKSON, LINCOLN, MCDOWELL, MACON, MADISON, MITCHELL, POLK, RUTHERFORD, TRANSYLVANIA, WATAUGA, WILKES, AND YANCEY. If your county is not listed, please contact us for further support.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Residence Information

  • Type of Residence*
  • Do you own or rent?*
  • Disaster Information

  • Disaster was the result of:*
  • Is the residence located on a Flood Plain?
  • Extent of Damage*
  • Insurance Information

  • Do you have insurance?
  • Do you have flood insurance?
  • Insurance covers:
  • Was insurance sufficient to cover all the damages?
  • Employment and Income

  • Were you employed before the disaster?
  • Did you lose your job as a result of the disaster?
  • FEMA and Other Assistance

  • Did you apply for assistance from FEMA?*
  • If yes, did you also fill out the application for a SBA loan?
  • Assistance Requested

  • Type(s) of Assistance Needed*
  • Do you have a plan for recovery?
  • Have you obtained estimates for repairs or replacement?
  • Have you obtained permits/inspections?
  • Applicant Statement

  • I agree and affirm that I am making Volunteer application for assistance for disaster relief from the Unmet Needs Project. I understand that the information contained in this application and the accompanying Individual/Family Plan for Recovery and the Release of Confidential Information form will be utilized by the Unmet Need Project to assist me with my disaster-related needs. I understand that the assistance is not guaranteed and that the case manager does not make the final determination of the availability of funds or other kinds of help. My signature below signifies that I have read and/or understand this document and the service being provided me.
  • Date*
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  • Date
     - -
  • Should be Empty: