AT&T Pioneers Disaster Relief Fund Application

AT&T Employees and Retirees affected by State or Federal declared disasters are eligible to receive assistance from the AT&T Pioneers Disaster Relief Fund.  The fund is managed by the AT&T Pioneers National Disaster Relief Committee.  This application is owned by the AT&T Pioneers and used for applicants needing financial support for FEMA declared events (individual assistance) from the AT&T Pioneers Disaster Relief Fund. 

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Are you currently an AT&T employee (If yes, what is your AT&T UID)?

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* 4. If you are an AT&T Retiree please answer the following questions. 

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* 5. What is your contact phone number? * use (xxx) xxx-xxxx format

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* 6. What is your email address

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* 7. Please re-enter your email address

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* 8. Which FEMA declared event are you affected by? (DR # located on FEMA website)

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* 9. Residential address (affected by the disaster)?

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* 10. Is this your primary residence?

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* 11. Do you own or rent the residence?

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* 12. Date of event (when damaged / loss occurred)

Date / Time

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* 13. Date you completed application 

Date / Time

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* 14. Provide detailed description of the property damage (damages to structures, loss of property, financial needs). Lack of detail may delay the processing of your application.

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* 15. Provide any other information that is relevant to your application

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* 16. I understand the AT&T Pioneers may suspend, amend, or discontinue this program at any time, and the AT&T Pioneers Disaster Relief Fund Committee reserves the right to refuse funding to non-qualifying applications.

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* 17. I understand the AT&T Pioneers Disaster Relief Fund can only be awarded to one residence / dwelling  (i.e. one application per household).

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* 18. I understand by submitting this application, the information submitted is true and correct (Please signify you understand and agree by typing in your first and last name in the text box)

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* 19. What address would you want your response mailed?

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