De Pere Fire Relief Fund Application
On April 24, 2019, an historic building collapsed during a massive fire on De Pere’s east side. Definitely De Pere, in consultation with the City of De Pere and Brown County United Way, has established the De Pere Fire Relief Fund. The purpose of this fund is to assist individuals and businesses affected by the fire with their immediate unmet needs.

Online applications will be accepted until Wednesday, June 12, 2019 by 4:30pm.

Name
Your answer
Business Name
Your answer
Current Address
Your answer
City/State/Zip
Your answer
Phone Number
Your answer
Email Address
Your answer
Under which category are you applying for a grant?
Residential or business address at the time of the fire:
Your answer
Please describe how you were affected by the fire.
Your answer
What is your estimated net loss after insurance coverage and any other fire assistance received?
Your answer
Grant dollar amount requested:
Your answer
Note: The amount granted may be less than what is requested depending on the availability of funds. Any application in which the amount requested is reduced may be reviewed for additional funding should it become available.
Please list any other sources and amounts of financial assistance you have received for support and recovery from the fire.
Your answer
How do you plan to use the grant? Check all that apply.
Certification by Applicant
I certify that I have suffered a loss due to the De Pere fire which occurred on April 24, 2019 as stated in this application and that all information contained in this application is true and complete.

I understand that a fraudulent representation or omission of any information requested is grounds for immediate refusal for a grant from this fund. I certify that I will use all grant dollars I may receive from the De Pere Fire Relief Fund as stated in this application.

I understand a grant from this fund is neither a right nor an entitlement, and that the De Pere Fire Relief Fund Application Review Committee shall have sole discretion in determining whether I qualify for assistance.

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