• Avoyelles Early Recovery

  • Tell us about you.

  • Format: (000) 000-0000.
  • Are you able to continue living in your home?*
  • Thinking about the work that still needs to be done, which best describes where things stand?*
  • What work is still left to do?*
  • How are you planning to the remaining work done?*
  • If a trained volunteer group could help with some of the work at no cost, would having some extra hands help you get back to normal sooner?*
  • Would you mind answering a few more questions to help us better understand where you're at?*

  • Tell us about the property.

  • Was the affected address your*
  • Do you own the home?*
  • Which best describes the home?*
  • About how much water got inside your home at its highest point?*
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  • Do you have homeowner's insurance?*
  • Were your damages covered by insurance?*
  • Do you have flood insurance?*
  • Were your damages covered by your flood insurance?*
  • Did you apply with FEMA?*
  • What is keeping the work from being finished?*

  • Release For Assistance

  • Why we are asking for your permission

    Building a Better Avoyelles is working with trusted local churches, nonprofit organizations, and trained volunteers to help disaster survivors recover. To connect you with the assistance you need, we may need to share some of your information with people who are directly involved in helping you.

    We value your privacy and will only share the minimum amount of information necessary to provide assistance.

    Information We May Share
    Depending on your needs, we may share:

    • Your name
    • Address
    • Telephone number
    • Preferred contact information
    • General description of your disaster-related needs
    • Information needed to coordinate recovery services
    • We will not intentionally share sensitive information such as Social Security numbers, banking information, insurance documents, government identification numbers, or medical information unless you specifically authorize us or it is legally required.

    Who May Receive My Information
    Your information may be shared only with:

    Building a Better Avoyelles staff
    Trained Building a Better Avoyelles volunteers
    Disaster case managers
    Faith-based recovery organizations
    Nonprofit partners
    Long-Term Recovery Group partners
    Government agencies when necessary to coordinate disaster recovery services
    All individuals who receive your information are expected to protect your privacy and use your information only to assist with your recovery.

    How Your Information Will Be Used
    Your information may be used to:

    Contact you to verify your current needs
    Coordinate volunteers
    Assess eligibility for assistance
    Match you with available recovery resources
    Coordinate rebuilding, cleanup, or other disaster recovery services
    Avoid duplicate services among participating organizations
    Your information will never be sold or used for marketing.

    Your Rights
    You have the right to:

    Ask questions before signing.
    Decline to authorize the sharing of your information.
    Revoke your consent at any time by contacting Building a Better Avoyelles.
    Request a copy of the information we maintain about your recovery case, where applicable.
    Declining consent will not affect your dignity or respect; however, it may limit our ability to coordinate assistance on your behalf because we may not be able to share information with organizations that could help you. Disaster case management guidance recommends written, informed, voluntary, and time-limited consent for sharing client information.

     

    This authorization remains in effect until:

    • My case is closed
    • One year from today's date
    • I revoke my consent in writing 
  • I have read (or had explained to me) the information above. I voluntarily authorize Building a Better Avoyelles to collect, store, and share the minimum necessary information needed to coordinate my disaster recovery services.*

  • For Avoyelles Early Recovery Staff ONLY:

  • Was verbal consent given?
  • Should be Empty: