Client Interest Form
In
select communities
across the Southeast, Strongward offers
homeowners
assistance with filing FEMA appeals and with home repairs. This questionnaire will help us determine if you are a good fit for our program. Please submit this form only once. If your submission matches our current program requirements, a representative from our team will contact you within 5-10 business days. This form should take less than 5 minutes to complete.
Please note that submitting this form is not an application for or guarantee of services.
Assistance Needed
Do you own the property and possess a clear title, currently and at the time of the disaster?
Yes
No
Does the property serve as your primary residence, currently and at the time of the disaster?
Yes
No
Have you applied to FEMA for assistance within the last 18 months AND need help appealing FEMA's decision?
Yes
No
Do you have unmet home repair needs AND need help making the repairs?
Yes
No
Has the home been demolished or has the local municipality sent notice indicating the home is substantially damaged or requires elevation?
Yes
No
Is the home a mobile, manufactured or modular home?
Yes
No
Strongward unfortunately does not have any programs able to help you at this time
. Check out our
Resource Hub
for tools to support your recovery.
We may be able to help you appeal FEMA’s decision
.
Please provide details on the home you own that was impacted by a natural disaster.
We may be able to help you with home repairs
.
Please provide details on the home you own that was impacted by a natural disaster.
You may be eligible for one or more Strongward programs.
Please provide details on the home you own that was impacted by a natural disaster.
Homeowner Information
First Name
Last Name
Email
Mobile Phone
Have many people are in your household?
What is your household's estimated annual income this year?
$
Property Information
Street Address
If street address does not auto-populate, use Google Maps to obtain the correct address format. Use abbreviations for common terms like highway and south.
City
State
Zip Code
Additional Information
How did you hear about Strongward?
Disaster Case Manager Agency
Disaster Case Manager
Name
Disaster Case Manager
Phone Number
Disaster Case Manager
Email
Is there any additional information you want to share to help our team understand your current needs and situation?
If you were referred by or are working with a case manager, please provide their full name, agency name and phone number so we can be sure to collaborate with them as appropriate.
Attestation
I attest that the information provided is true and complete to the best of my knowledge.
Contact Information