Disaster Relief Requests Social share icons You must have JavaScript enabled to use this form. Leave this field blank Union Member's Name Member First Member Middle Member Last Member Suffix Union Household Address Member Address Member Address 2 Member City/Town Member State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Member ZIP/Postal Code Member's International Union Member's International Union - Select -AFGEAFMAFSCMEAFTAPWUATUBACBCTGMCWAIAFFIAMAWIATSEIBBIBEWIBTIUECIWIUOEIUPATLiUNANALCNNUNPMHUOPCMIAOPEIUROOFERSRWDSUSMART UTUSEIUUAUAWUFCWUMWAUNITE-HEREUSWOther… Enter other… Local Union Union Member Email Union Member Phone Number Impacted Property Description Please describe how the disaster impacted your family and caused damage to your property. Assistance Request We are proud to inform you of the Union Member Disaster Relief Fund, established and administered by the Kentucky State AFL-CIO, the Greater Louisville and the United Way of Kentucky. The fund was established thanks to the generous gifts from local unions and concerned union activists from across Kentucky and the nation, in hopes to support your family’s recovery following your disaster event. Fund resources are available to assist disaster impacted union households with the payment of recovery related expenses of up to $1,500 to billing entities, such as: contractors, utility bills, insurance company deductibles, mortgage/rent payments, and other requests as approved by the partners. Funds must be directed to the billing entity and CANNOT be paid directly to impacted union families.Any request for Utility/Rent/Mortgage Assistance must be for a union member's primary address (impacted or displaced residence).Combined assistance will not exceed $1500 for each union household. Resubmit this form for each request. Please submit your requests in order of priority. Impacted Property Photo(s) Upload One file only.100 MB limit.Allowed types: gif, jpg, jpeg, png. Billing Entity to be Paid (Company/Utility) Billing Entity Address Billing Entity Address 2 Billing Entity City/Town Billing Entity State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Billing Entity ZIP/Postal Code Support payments will be sent directly to the billing entity and not individuals. Please include a mailing address to the billing entity. Name of Billing Entity (Company/Utility) Account or Reference Number or Customer ID Include any necessary account number, reference numbers, or customer ID for payments to be credited to you. Amount Requested Billing Entity Phone Number Additional Needs Please share any additional needs with which we may be able to help. Submit
