Relief Fund Application Question Title * 1. Please provide your full name Question Title * 2. Please provide your contact phone number Question Title * 3. Please provide your email address Question Title * 4. Home Location Question Title * 5. What type of residence is this address? Primary Secondary Question Title * 6. Please describe the extent of the damage to your property caused by Hurricane Helene Question Title * 7. Is your home currently habitable? Yes No Question Title * 8. What types of damage did your property sustain? (Select all that apply) Roof damage Flooding Structural damage Electrical damage Plumbing damage Broken windows Other (please specify) Question Title * 9. If you selected 'Other' in the previous question, please specify the type of damage Question Title * 10. Do you have insurance coverage for the damages? Yes No Question Title * 11. If you have insurance, please provide details of your coverage and any challenges you have faced with your claim Question Title * 12. Do you need immediate temporary housing assistance? Yes No Question Title * 13. What types of assistance do you need? (Select all that apply) Financial assistance Temporary housing Food and water supplies Clothing Medical assistance Other (please specify) Question Title * 14. If you selected 'Other' in the previous question, please specify the type of assistance needed Question Title * 15. Was your place of business or job impacted by Hurricane Helene? Question Title * 16. Have you received any assistance from other organizations? (FEMA, American Red Cross, etc.) Question Title * 17. Please provide any additional information that you think is important for us to know Done
