Hurricane Recovery Assistance

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Hurricane Recovery Assistance

Hurricane Recovery Assistance Application

If you are a family who is licensed through the Safe Children Coalition, please use the following link to apply for Hurricane Recovery Assistance: https://form.jotform.com/242995177934170

Please note that Hurricane Recovery Assistance through Bridge a Life is for caregivers of children who have been adopted, or are part of the child welfare system. By clicking this box I verify that the below applicant is a foster or adoptive parent, relative/non-relative caregiver, or a parent with child welfare involvement.

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By clicking this box I verify that I am submitting this application due to damages or loss as a result of a recent Hurricane.

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Is this need a result of a recent hurricane? *

Is this need a result of a recent hurricane?

Yes

No

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Impacted Hurricane(s):

Impacted Hurricane(s):

Debby (August 2024)

Helene (September 2024)

Milton (October 2024)

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Name *

Please type your full name.

Current Address: *

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Phone #: *

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Email *

Invalid email address.

Brief description of family that resides in the home: *

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Number of People in Household:

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Are you renting, or do you own the residence?

Are you renting, or do you own the residence?

I am the owner

I am renting

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Project Information

Project Address:

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Type of Assistance Needed:

Type of Assistance Needed:

Construction

Materials

Appliances/Furniture

Financial Assistance

Other (explain)

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Brief Description of Project and type of assistance needed

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Are funds available to purchase materials? (if yes, how much)

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Total Amount Being Requested:

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Was an insurance claim filed with your insurance? If yes, what was the outcome:

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Was a claim filed with FEMA? If yes, assistance received?

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Please share product/service information weblink:

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What attempts have you made to secure this product or service at a reduced rate?

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How would this project benefit the family?

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Upload Documents related to this request (quotes, damage images, etc)

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Licensing Agency Information (if applicable)

Name of Licensing Agency (if applicable):

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Case Manager's Name:

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Case Manager’s Phone Number:

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Case Manager’s Email:

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Your Church Home (if applicable)

Church Name:

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Church Address:

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Church website:

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Church Phone Number:

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Pastor/Staff Member Name:

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Pastor/Staff Member Email:

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941-306-8628

9015 Town Center Parkway Suite #126
Lakewood Ranch, FL 34202

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He will cover you with his feathers and under his wings you will find refuge; his faithfulness will be your shield and rampart.
– Psalm 91:4

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