Storm Impact Survey
Hawaiʻi Community Lending is gathering information to better understand how the recent storm has impacted our community. If your home or property experienced damage, please complete this short survey. Your responses will help us identify community needs and understand where those needs are across our communities. Questions? Contact kokua@hawaiicommunitylending.com or call us at 808-587-7656. Also, find us on our socials @hawaiicommunitylending on Instagram and Hawai'i Community Lending on Facebook.
First and Last Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Did your home or property experience any damage as a result of the recent storm?
*
Yes
No
What type of damage did you experience? (Select all that apply)
*
Roof damage
Flooding (inside home)
Structural damage (walls, foundation, etc.)
Electrical damage
Plumbing/sewer issues
Damage to personal belongings
Yard/land damage (erosion, fallen trees, etc.)
Cesspool failure (caved in cesspool and needs replacement)
Other
Severity of Damage
*
Minimal Damage
1
2
3
4
Severe Damage
5
1 is Minimal Damage, 5 is Severe Damage
Is your home currently safe to live in?
*
Yes
No
Where are you currently staying?
*
Are you Native Hawaiian?
*
Yes
No
Do you live on Hawaiian Home Lands?
*
Yes
No
Homestead Area
*
Do you have a current homeowners insurance policy?
*
Yes
No
I'm not sure
Do you have FLOOD insurance?
*
Yes
No
I'm not sure
Who is your insurance provider for your homeowners policy?
*
Have you filed a claim related to this damage?
*
Yes
No
Have you applied for any disaster assistance?
*
Yes
No
Would you like to be contacted for assistance or resources?
*
Yes
No
Damaged Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please describe the damage or your situation in your own words (OPTIONAL):
Please feel free to upload pictures of any damage (OPTIONAL)
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