relief.ltafoundation.org

LTA Foundation Disaster Relief Application

Application Acceptance & Review - Rolling Basis
Thank you for your interest in receiving assistance from the Lambda Theta Alpha Foundation. The Lambda Theta Alpha Foundation Disaster Relief Fund was established to help provide relief to those affected by a natural disaster in the United States.

Please review all questions and ensure all information is correct and accurate. We ask that you provide as much detail as possible, as all information provided will assist in determining need and support. If any questions should arise, please contact us at info@ltafoundation.org.

Eligibility Criteria for Disaster Relief:

1. Impacted by a natural disaster in th U.S. (i.e. hurricane, tornado, fire, etc.)

2. Documented expenses beyond what is covered from insurance if applicable.

** Forms of Proof Are Required - SEE BELOW **
I. Personal Data:

Tell us about yourself
E-mail:*
Where the confirmation will be send to
1. Are you applying on behalf of someone other than the person completing this application? (If Yes, please answer Questions 2 and 3)*

YesNo (skip to Question 4)
2. Recipient Full Name:

First NameLast Name
3. Recipient E-mail:
Where the confirmation will be send to
4. Recipient / Applicant Mobile Number:*

Area CodePhone Number
2. Applicant Full Name:*

First NameLast Name
5. Home Address:*

Street Address

Street Address Line 2

CityState/Province

Postal/Zip CodeCountry
6. Are you a member of Lambda Theta Alpha Latin Sorority, Inc?*

YesNo
7. If yes, provide the Chapter, Semester and Year initiated
8. Are you a member of another Fraternal Organization?

YesNo
9. If yes, please provide the name of the Organization:
II. Disaster Effects:
10. For which Natural Disaster are you requesting relief?*
11. Are you (or the Relief Recipient) currently displaced due to a natural disaster?*

Yes, staying in local shelterYes, staying with family friendsYes, but it is temporaryNo, I have not been displacedNo, but I am housing individuals whom are displaced
12. Please briefly describe the reason for your request, how has the recent Disaster affected you or the Recipient, please include details on any losses or hardships incurred:*
13. How much money (up to $500) do you need to help provide relief?*
14. Please briefly describe how the relief award would benefit the Recipient:*
III. Forms of Proof & Supporting Documentation:
15. I confirm that the damages/need noted above are not covered by insurance.*

No, the damages that the recipient sustained are not covered by insurance.Yes, the damages that the recipient sustained are partially or completely covered by insurance or other third party funding agency
Forms of Proof are required for evaluation and processing.
- Invoices or receipts of purchases made as a result of natural disaster
- Proof that the damages (or need) are not covered by insurance.
- Photos of loss or damaged property (if applicable
16. PLEASE SUBMIT: Invoice/Receipt(s) *
17. PLEASE SUBMIT: Proof Need is Beyond Insurance Coverage*
18. PLEASE SUBMIT: Photos/Proof of Damage*
19. PLEASE SUBMIT: Supporting Document
20. How did you hear about the LTA Foundation & our COVID-19 Relief Campaigning?*

LTA Foundation WebsiteEmailFacebookInstagramGoogle SearchLambda Theta Alpha MemberFriendOther
VII. Applicant's E-Signature
I have read and understand the instructions and understand that not following the directions provided and/or providing all information requested below will disqualify my application.*

YesNo
E-Signature:*
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
The Lambda Theta Alpha Foundation, Inc. is committed to equal opportunity in employment and education. The Foundation does not discriminate on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.

The Lambda Theta Alpha Foundation's mission is to advance the community through humanitarian relief, educational programming, and scholarship. Please visit our website for additional information.
Should be Empty:

LTA Foundation Disaster Relief Application

I. Personal Data:

II. Disaster Effects:

III. Forms of Proof & Supporting Documentation:

VII. Applicant's E-Signature