Georgetown University Relief Fund Application

Applicant information

Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parish(Required)

Applicant Type

Phone(Required)

Email(Required)

Property Damaged(Required)

Estimated Damages(Required)

Type of Assistance Needed

If Other, please specify

Impact Data

# of Adults(Required)

# of Dependents(Required)

Ages of Adults(Required)

Ages of Dependents(Required)

Household Income Range(Required)

Needs Assessment Narrative(Required)

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Proof to support Loss/Damage property location, Hurricane Ida August 29, 2021:(Required)

File Upload(Required)

Max. file size: 50 MB.

Proof to support Loss/Damage property location, Hurricane Ida August 29, 2021(Required)

File Upload(Required)

Max. file size: 50 MB.

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