United Way Thomas Fire & Flood Fund - Santa Barbara County

Application for Individual Assistance

In order to be eligible for funding, you must submit an application for individual assistance.

If you need assistance filling out your application, please visit United Way of Santa Barbara County (Mondays, Wednesdays, and Fridays between 1:00pm and 5:00pm; located at 320 East Gutierrez Street, Santa Barbara. Contact: Melinda Cabrera), the Montecito Center (Open Monday through Friday 10am-3pm, Wednesday 6pm-8pm, and Saturday 10am-2pm; located at 1283 Coast Village Circle, Montecito, CA 93108), or Family Service Agency (Open Monday through Friday 9am-5pm, 123 West Gutierrez Street, Santa Barbara, CA 93101).

Applications will be accepted from April 16, 2018 through May 11, 2018. Your application must be received by 5pm on Friday, May 11, 2018 to be eligible for funding from this distribution. Late applications will be accepted past May 11th, but will only be reviewed at a later date, should additional funding become available.

Upon submission, your application will be sent to Family Service Agency, United Way of Santa Barbara County’s contracted partner agency for case management services. A representative from Family Service Agency will contact you to set up an appointment to review your application. Please do not contact Family Service Agency; they will contact you.

You must bring the required documentation to this meeting in order for your application to be reviewed. Acceptable documentation is as follows:

Proof of primary residency at time of the Thomas Fire and/or 1/9 Debris Flow. You are required to bring Photo ID (Driver’s license, US or foreign passport, or CA ID card) and one of the following other documents: Tax Return, Voter Registration, utility bill, or bank statement.
For applicants under the “loss of job or work: class, proof of employment documents at time of the Thomas Fire and/or 1/9 Debris Flow that show proof of loss of job or work. You are required to bring one of the following documents: 2 pay stubs or letter from employer confirming closure at time of disaster.

During your meeting, you and your Family Service Agency representative will review your application and required documentation, as well as discuss your needs. It is your responsibility to honor your appointment time. Your application will not be considered complete until you meet with your assigned Family Service Agency representative. Due to the high number of applications received, FSA will contact you as time allows.

Upon completion of your application and your meeting with Family Service Agency, United Way of Santa Barbara County will review your full application and funding recommendation from FSA and provide written notice of a funding decision.

For the Fund’s Phase Two Individual Assistance Distribution, the following classes of individuals are eligible to apply for funding:

Next of Kin for individuals who lost their lives as a result of the 1/9 Debris Flow.
Santa Barbara County residents who have suffered damage or total loss of their primary residence (including renters) and/or personal property (vehicles included) due to the Thomas Fire or 1/9 Debris Flow.
Santa Barbara County Residents who were unable to work during or after the Thomas Fire or 1/9 Debris Flow.

UWSBC retains the right to adjust final funding decisions based upon the number of total applicants and funding available.

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* 1. Current Contact Information

Name *

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 2. At your application review meeting, you will need to bring documentation to demonstrate proof of primary residency in Santa Barbara County at the time of the Thomas Fire and/or 1/9 Debris Flow. You are required to bring Photo ID (Driver’s license, US or foreign passport, or CA ID card) and one of the following documents: Tax Return, Voter Registration, utility bill, or bank statement.

Do you have this documentation? If not, you may still submit an application.

Yes

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* 3. For applicants under the “loss of job or work" class, at your application review meeting, you must be a Santa Barbara County resident and ALSO provide documents demonstrating proof of employment in Santa Barbara County at time of the Thomas Fire and/or 1/9 Debris Flow and that show loss of job or work. You are required to bring one of the following documents: 2 pay stubs or letter from employer confirming closure at time of disaster.

Do you have this documentation? If not, you may still submit an application.

Yes

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* 4. Current Housing Information:

Homeowner

Rent

Shelter

Homeless

Temporarily living with friend/relative

Other (please specify)

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* 5. Up to date with rent or mortgage?

Yes

N/A

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* 6. Rent/Mortgage & Utility Information

Last paid rent date:

Rent amount:

Rent due date:

Average monthly utlities amount:

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* 7. Address Where Damage Occurred (write N/A if not applicable)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 8. If damage occurred at rental, please provide landlord information

Landlord Name

Landlord Phone Number

Landlord Email Address

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* 9. Which class of funding are you applying for?

Next of Kin for individuals who lost their lives as a result of the 1/9 Debris Flow.

Loss or Damage of Primary Residence and/or Personal Property (vehicles included) due to the Thomas Fire and/or 1/9 Debris Flow

Loss of Job or Work due to the Thomas Fire and/or 1/9 Debris Flow

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* 10. Amount of funding requested

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* 11. Describe your loss and need.

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* 12. Which (if any) insurance coverage did you have at the time of the Thomas Fire and/or 1/9 Debris Flow?

Homeowners

Renters

Auto

None

Other (please specify)

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* 13. Explain any gaps in your insurance coverage related to your request.

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* 14. Please enter funding received from insurance, FEMA, and grants from other funding organizations (i.e., Direct Relief, 805UndocuFund, 93108Fund, GoFundMe, etc.).

Insurance payments

FEMA

Other funding organization 1 (please list source and amount)

Other funding organization 2 (please list source and amount)

Other funding organization 3 (please list source and amount)

Other funding organization 4 (please list source and amount)

Other funding organization 5 (please list source and amount)

TOTAL AMOUNT RECEIVED:

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* 15. Please enter yourself and each member of your household.

Household member 1 (enter Head of Household here)

Household member 2 (Name, Relation to Head of Household, Age)

Household member 3 (Name, Relation to Head of Household, Age)

Household member 4 (Name, Relation to Head of Household, Age)

Household member 5 (Name, Relation to Head of Household, Age)

Household member 6 (Name, Relation to Head of Household, Age)

Household member 7 (Name, Relation to Head of Household, Age)

Household member 8 (Name, Relation to Head of Household, Age)

TOTAL NUMBER OF HOUSEHOLD MEMBERS (INCLUDING YOURSELF)

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* 16. Housing - At time of disaster

Own

Rent

In process of buying

Homeless

Temporarily living with friend/relative

Other (please specify)

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* 17. Employer Information for Individuals Applying for Lost Job or Work (write N/A if not applicable)

Supervisor Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 18. Total Annual Household Income *Please note: your answer to this question will not affect your eligibility or funding decision. It is requested to track demographics.

Less than $25,000

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $149,999

$150,000 to $199,999

$200,000 or more

By submitting this application, I agree to the following:

Personal identifying information will be collected and used to determine funding eligibility and amount.
Collected information will be shared between Family Service Agency, the designated case management agency for the United Way Thomas Fire & Flood Fund, and United Way of Santa Barbara County.
Family Service Agency will contact me to set an appointment to review this application and all required supporting documents.

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