Hurricane Relief Aid Application
Please fill in all applicable information. The applicant must present ID to receive disbursed funds. If you would like to fill out a paper copy, please find the pdf here: http://wilmingtonoca.org/wp-content/uploads/2018/10/2018-HFRF-Aid-Request-Form.pdf
Applicant Name
Last Name *
Your answer
First Name *
Your answer
Primary Residence
Street Address *
Your answer
City, State, Zip *
Your answer
Temporary Residence (If Applicable)
Street Address
Your answer
City, State, Zip
Your answer
Contact Information
Home/Work Phone Number
Your answer
Mobile/Text Phone Number
Your answer
Email Address
Your answer
Applicant Status *
Sheltering Situation *
Aid Request
Needs *
Required
Amount of Aid requested *
Your answer
Submit
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This form was created inside of St. Basil the Great Orthodox Church.