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About
Who We Are
Our Mission
What We Believe
Store
Board Of Directors
FAQ
Ambassador Program
Projects
Contact
Need Help?
Volunteer
Work Dates
Donate
WNC Operation Helene Rebuild Request for Assistance Questionnaire
WNC Operation Helene Rebuild Request for Assistance Questionnaire
Step
1
of
5
20%
Contact Information
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
County
Home Phone Number
Cell Phone Number
Email
Applicant Information
Do you own the home?
Yes
No
If not, explain
Do you have clear title to the home?
Yes
No
If not, explain
Do you have homeowner’s insurance?
Do you have flood insurance?
Is your property located in a Special Flood Hazard Area, as determined by the county or FEMA?
Age? (If willing to share)
Family Status
Married
Divorced
Single
Do you have children?
Yes
No
If so, what are their ages?
Are they able to help?
Number of Adults living in the home
Number of Children living in the home
What is your occupation?
Household income per month
Expenses per month
Health status: Please list any health issues of any family members:
Vision
Hearing
Speech
Other health issues
Need for handicap accessibility?
Yes
No
If yes, explain:
Do you have a local church family? If so, where?
Are you and your family members willing/able to help with the project?
Are you living in the home currently?
Yes
No
If no, why?
If not in the home do you have temporary housing?
If in the home are you able to live elsewhere during renovations/rebuild?
Are you able to maintain the property & insurance ongoing?
Yes
No
If no, explain:
Home Information
Is the home
Framed
Manufactured
Age of the home
Number of bedrooms
Number of bathrooms
Is there a garage?
Yes
No
What is the foundation:
Slab
Crawl Space
Style of house:
Ranch
Two story
Split level
Roof type:
Shingle
Metal
Other
Siding type:
Brick
Wood
Vinyl
Other
Assistance requested:
What is the nature of the problems to be corrected? Please attach pictures (upload at the end of the form) or additional information as available.
Urgency:
Any urgent health or safety risks associated with this need? (Ex: mold, wiring, etc.) If yes, explain:
Are there any timeline issues we need to be aware of? (ex: Finish by certain date.) If so, explain.
Additional Information:
Are there any other governmental or non-governmental agencies with which you have applied for assistance for this/these issues? If yes, please explain.
Please provide any additional information you feel will be helpful in analyzing this case.
Has FEMA provided you with a letter regarding funds for damage to property?
Has FEMA provided you with a letter stating that you are required to obtain flood insurance and that the money they give you may be required to be returned to FEMA if you don’t obtain flood coverage?
Have you obtained a new flood policy or are you planning to obtain a new flood policy?
Required Documentation
Drop files here or
Select files
Max. file size: 50 MB.
Please provide copies of FEMA letters, county damage assessments, etc.
