Disaster Request

Please complete all required elements for your application to be considered and note there are required attachments at the end of the application. Four attachments are allowed for each file upload section, but each section may not be more than 2MB in total size. If you are unable to reduce your files, please contact us at 817-847-7700 for assistance.

Name ^* (required)

AAPL Member # ^* (required)

Contact Information

Address Line 1 ^* (required)

Address City ^* (required)

State ^* (required)

Zip Code ^* (required)

Primary Residence (If different from above)

Phone ^* (required)

Email ^* (required)

Additional Information

Employment or Independent ^* (required)

Date of Natural Disaster ^* (required)

Were you directly impacted by a natural disaster? ^* (required)

Yes

Were you directly impacted by a state or federally declared natural disaster? ^* (required)

Yes

Do you own or rent your primary residence? ^* (required)

Yes

Did your primary residence sustain damage as a result of a natural disaster? ^* (required)

Yes

Did your primary residence sustain damage as a result of a state or federally declared natural disaster? ^* (required)

Yes

Are you personally experiencing financial hardship as a result of a natural disaster? ^* (required)

Yes

Were you or are you currently displaced from your primary residence as a direct result of the referenced disaster? ^* (required)

Yes

If yes, please address your temporary housing situation.

Are you in need of financial assistance as a result if a natural disaster? ^* (required)

Yes

Do you have adequate financial means to cover your financial needs as a result of a natural disaster? ^* (required)

Yes

Is your damage/loss covered by any insurance policy?

Yes

If yes, have you filed a claim with your insurance carrier?

Yes

How much of the damage/loss is covered by your insurance policy? ^* (required)

What is your insurance deductible? (If applicable)

If you have filed a claim through the National Flood Insurance Program, what is your flood certification number?

What is your total estimated financial loss? ^* (required)

Is the damage sustained by your primary residence considered a “total loss”? ^* (required)

Yes

What is the total amount you are requesting from the Foundation and what does it cover? Please provide an itemized list: ^* (required)

Please provide a detailed description of the natural disaster and the loss suffered and type of assistance needed, and of your current financial condition. ^* (required)

Please submit the insurance report, so that we can verify what is being covered and what is not being covered by insurance. ^* (required)

Browse

REQUIRED: Please upload at least two photographs of your primary residence following the natural disaster; one photo must show the address of your primary residence. ^* (required)

Drag a file here to upload (.PPS/.PPTM/.DOTM/.XLAM/.XLSX/.XLA/.DOCX/.DOTX/.POTX/.PPT/.XLT/.DOCM/.PPSX/.DOC/.CSV/.XLTX/.PDF/.PPA/.PPAM/.XLS/.ZIP/.XLSM/.DOT/.PPTX/.PPSM/.XLSB/.XLTM/.TIFF/.POTM/.POT/.TIF/.PNG/.GIF/.JPG/.TIFF/.SVG/.WEBP/.JPEG)
Upload

Please upload any applicable repair estimates.

Your property may be subject to an in-person site visit. Please be aware, if you complete any part of this application untruthfully, you may be subject to an AAPL ethics violation and/or other legal remedies.