Natural Disaster Grant Application – Michael R. Walker Foundation

MRWF - Natural Disaster Grant Application

Please Note: The affected home must be the employee's primary residence, uninhabitable due to a natural disaster/fire and the employee is currently displaced from their home. Home maintenance or repair situations do not meet the Foundation’s criteria and will not be considered.

Step 1 of 2

Employee Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Employee ID(Required)

Home Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

County of Residence(Required)

Center/Site Location(Required)

Please select Division/Market that applies to you(Required)

Job Title(Required)

Hire Date(Required)

Shift/Time usually at work(Required)

Employment Status(Required)

Hours Per Week(Required)

Who is filing out the form?(Required)

If not applicant, please supply name, title and relationship to employee(Required)

Date(s) of Hardship(Required)

Please describe the hardship/situation details(Required)

Family/Household Demographics

Number of Adults(Required)

Number of Children(Required)

Relation to Employee(Required)

Natural Disaster/Fire Additional Details

What type of Natural Disaster?(Required)

If you selected "Other", please describe in detail below.(Required)

Own or Rent?(Required)

Extent of Loss (i.e. Full, Partial, etc.)(Required)

Please describe the extent of the loss(Required)

Where is the employee currently staying?(Required)

Is there current homeowner or renter insurance coverage?(Required)

If Yes, is there a deductible? If so, how much.(Required)

Supporting Documentation - Please upload all supporting documentation (i.e. fire report, pictures, insurance, etc.)

Max. file size: 768 MB.

If you are unable to upload, please fax to 610-347-6217 or email to mrwfoundation@genesishcc.com

Is there other assistance being given (American Red Cross, etc.)?(Required)

If Yes, please describe.(Required)

Funds

Requested Amount(Required)

How will grant funds be used?(Required)

If a grant is approved, will you allow MRWF to share your story?(Required)

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Grant Coordinator