First Name *

Last Name *

Phone

Are you ok?

Yes

No

Do you have a place to live?

Yes

No

Temporarily

How is your power?

Operational

Inoperative

Do you have running water?

Yes

No

Do you have access to food and water

Yes

No

Do you have transportation?

Yes

No

Please Provide a severity assessment

Level 1 (Low) - may not have power, water, or internet but have food, water, and little to no damage to my home

Level 2 (Medium) - minor damage to home but livable, no transportation, running out of supplies such as food and water

Level 3 (High) - house is flooded or not livable (even if I currently have a place to stay); no food or water to drink

Level 1

Level 2

Level 3

What is it that you will need help or resources with?

Are you familiar with the Florida Realtors Disaster Relief Fund?

Florida Realtors Disaster Relief Fund application below

The links for the two applications are here: https://www.floridarealtors.org/about/charities/disaster-relief-fund

Applicants must be a member of the Realtor® family prior to the disaster and whose home or real estate office has sustained serious physical and/or structural damage including but not limited to water intrusion.

The following types of damage may not qualify for assistance from the Disaster Relief Fund: loss of or damage to outbuildings, cars, boats, and recreational vehicles, pool and patio enclosures, pool pumps or pool equipment, blown shingles, personal property, landscaping including downed trees and debris removal, loss of perishable food, fencing, driveways and sidewalks, office signage, other minor damage and loss of income.

Complete all sections of the application. You must include:

· Color photos showing damage (digital preferred) and insurance summary page showing deductible and coverage information; and

· A written assessment from your insurance company and estimate to replace or repair damaged areas; include qualifying repair receipts to date and any additional information which may assist with describing your disaster and subsequent damage.

· Qualifying repair receipts to date and any additional information which may assist with describing your disaster and subsequent damage.

Brokers, two separate applications are required if both your broker office and residence sustained damage and they are not in the same location.

If anyone has questions regarding the completion of the assistance application, please contact Florida Realtors at 407-438-1400 or email drfclaims@floridarealtors.org.

Yes

No

Yes, I filed or am filing

Will you be able to continue your real estate business once all is restored?

For those who need assistance, the Disaster Unemployment Assistance is available even for independent contractors.

Yes

No

Unsure

If you are in great shape and want to volunteer to help others, what are you willing to do?

Select all that apply

Distribute needed items

Volunteer where needed

Manual labor cleaning/removing debris

Reaching out to members by phone

Donate supplies