Submit An Emergency Assistance Claim

Current LRFA members are eligible for financial assistance in cases of natural disaster or other catastrophic events. Complete the application form below to be considered for these benefits. After submitting this form, you may be contacted by LRFA for further information.

Your Information

Please fill out this field

Disaster Information

After completing this information, you may email us with supporting documentation and/or photos of the damage (homeowners insurance claim, estimates for repairs, etc).

Damage sustained due to:

*Please explain nature of event:

Date of event:

Please explain in detail the damage that occurred to your property:

Estimated cost of property damage:

Are you the sole owner of the damaged property?

If no, please explain:

Please fill out this field

Do you have any insurance coverage under which a claim for this incident may be made?

If yes, please provide details:

Are you eligible for support from any of the following agencies?

If you checked any of the above agencies, please explain:

Please email the following supporting documents to

Your signature

Submitting Form