Kerr County Flood Relief

Applicant Information

Full Name(Required)

First Middle Last

Date of Birth(Required)

Phone(Required)

Email(Required)

Primary Address Before Flood(Required)

Street Address Address Line 2 City ZIP / Postal Code

Current Address (if Different)

Street Address Address Line 2 City ZIP / Postal Code

Household Information

Total Number of People in Household(Required)

Names and Ages of Household Members(Required)

Please use a separate line for each household member

Are there any children under 18 in the household?(Required)

Yes

No

Are there any elderly or disabled members in the household?(Required)

Yes

No

Flood Impact Information

Was your home damaged by the flood?(Required)

Yes

No

Please describe the extent of the damage.(Required)

Was your vehicle damaged or lost?(Required)

Yes

No

Please describe the damage to your vehicle or the circumstances under which it was lost.(Required)

Did you lose employment or income as a result of the flood?(Required)

Yes

No

Please explain the circumstances under which you lost your employment or income.(Required)

Have you applied for assistance from FEMA or other organizations?(Required)

Yes

No

Please specify which assistance you have previously applied for.(Required)

Relief Needs

What type of assistance are you in need of?(Required)

Check all that apply:

Emergency Financial Assistance

Food & Essentials

Clothing

Temporary Housing Assistance

Transportation Assistance

Other:

Please explain your other relief needs.(Required)

Copy of Photo ID(Required)

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 10 MB.

Proof of Residence (utility bill, lease, etc.)(Required)

Accepted file types: pdf, doc, docx, Max. file size: 10 MB.

Photos of Damage (if available)

Drop files here or

Accepted file types: jpg, jpeg, png, heic, Max. file size: 10 MB, Max. files: 10.

Insurance Claim (if applicable)

Accepted file types: pdf, doc, docx, Max. file size: 10 MB.

Income Verification or Recent Pay Stub (optional)

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 10 MB.

Signature(Required)

Date(Required)

Want to Mail in Your Application Instead?

Please mail completed form and supporting documents to:

Want to Make a Donation?

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