APPLICATION PACKET FOR VCCDC S DISASTER RECOVERY GRANT: THOMAS FIRE/MONTECITO MUDSLIDE GRANT FUNDS PROVIDED BY: ADMINISTERED BY: Although eight months have passed since the Thomas Fire began its destructive path in Ventura County and the media attention has shifted, the need for financial assistance for those affected is still very much present. Ventura County Community Development Corporation (VCCDC) has joined forces with Wells Fargo to distribute $65,000 in financial assistance to those individuals and families still recovering from their losses caused by the Thomas Fire and/or Montecito Mudslide. IMPORTANT DETAILS Applications will be accepted beginning Monday, August 27 th at 10:00am Applications will be accepted until all qualified recipients have been identified. Applications will be reviewed in the order in which they are received. Notification of decisions will be made within 4 weeks after receipt of application. Grants will be awarded for up to $1,000 per affected household or business in the form of a check. o If both your household and business were affected, you can apply for both the personal and business grants. However, you will only be awarded 1 grant of up to $1,000. Applications will be accepted via mail, in person, fax, or email (see page 2 for details). o VCCDC is not responsible for applications that do not make it to our office or are received incomplete (i.e. lost in the mail, electronic error, etc.). o You will receive a confirmation email or call when your application is received Decision on grant awards will be made by VCCDC based on the information and documentation submitted along with the set eligibility criteria (see page 2 for details). VCCDC reserves the right to verify the information on this application to determine eligibility. If you have any questions please contact: Keily Victoria, VCCDC Administration Support Manager Kvictoria@vccdc.org or 805-273-7808 Page 1 of 5
ELIGIBILITY CRITERIA APPLICATIONS WILL BE REVIEWED IN THE ORDER RECEIVED Demonstrate direct or indirect financial impact related to the Thomas Fire and/or Montecito Mudslide Demonstrate a current need for funds Must be a resident of Ventura or Santa Barbara County One application per household No income or household size limits Previous financial assistance received from other sources will not affect eligibility VCCDC Board Members, Staff and their immediate family members are not eligible If awarded, grant recipients must agree to: (this will allow us to demonstrate impact and apply for more grants to help more families) o Provide a brief statement describing how funds assisted you o Attend a Rebuilding Together ceremony where checks will be distributed o Sign a photo and/or story release for media purpose WHAT YOU NEED TO SUBMIT Complete and SIGNED application (applications without your signature will not be processed) Proof of financial loss related to the Thomas Fire and/or Montecito Mudslide (see page 4) Explanation of how funds requested will be used (page 4) Copy of Driver s License or any other form of government-issued picture ID APPLICATION SUBMISSION APPLICATIONS WILL BE REVIEWED IN THE ORDER THEY ARE RECEIVED We are not responsible for applications that do not make it to our office or are received incomplete (i.e. lost in the mail, electronic error, etc.). You will receive a confirmation email or phone call within 24 hours of your application being received. Please return completed application and copies of documentation to: Via mail or in person (Monday Friday / 9am - 6pm; closed for lunch 12:30-1:30pm): VCCDC Attn: Keily Victoria 2231 Sturgis Road, Suite A Oxnard, CA 93030 Via Email: kvictoria@vccdc.org Via Fax: 805-604-1359 Applications will be accepted until all qualified recipients have been identified. Page 2 of 5
PERSONAL DATA Today s Date: / / Applicant s Full Name: Current mailing address: Telephone: Email: Address where damage occurred, if applicable (place of residence, business address, etc.): If you rented, name & telephone # of landlord: Approximate Current Household Income (after taxes): $ (For data gathering purposes only. This will not be used for eligibility purposes in any way.) Number of people in your household: Adults: Children: Total: Housing Situation - prior to the disaster Own Rent Homeless Living with relative/friend Other: Housing Situation - after the disaster Own Rent Homeless Living with relative/friend Other: DOCUMENTATION OF FINANCIAL LOSS How were you affected? (Check all that apply): My residence (house, apartment, etc.) was damaged or destroyed My business was destroyed or damaged I lost wages/business income I had no daycare for my children My belongings were damaged or destroyed My medical expenses increased due to health problems caused by the disasters Other: Were you insured for any of your losses? (i.e. homeowners, renters, auto insurance, etc.) Yes, I was fully insured for all of my losses. I was insured for only part of my losses. No, I was not insured for any of my losses. Page 3 of 5
Provide a brief description of how you were financially affected and how you would use the funds requested. If you need more space please attach an additional page to this application. Please submit a copy of any documentation which VCCDC can use to verify how you were financially affected. This can include, but is not limited to, one of the following: Verification of damaged/destroyed residence Proof of address such as tax returns, voter registration, driver s license (or other photo identification), utility bill Business damage/destruction Business license, business tax returns, other proof of ownership and business address Lost wages/work Company letterhead from employer verifying you lost wages/work for which you were not able to replace with vacation/pto or other sources. If selfemployed, letter from client indicating inability to pay you due to the disasters. Unavailability of daycare Letter from daycare provider stating they were unable to provide daycare services during the disasters causing you to use financial resources to identify other source of daycare. Include their contact information. Damaged/destroyed belongings Pictures of destroyed property and estimated value. Health problems Doctor s note certifying health condition related to the disasters and bills/receipts related to those health expenses. Other Any documentation you believe would assist VCCDC in verifying how you were affected can include proof of loss submitted for other relief/assistance grants. ADDITIONAL SERVICES AVAILABLE FROM VCCDC VCCDC provides the following free or low-cost services. Please check if you are interested in any of these services. You will be contacted to schedule an appointment. Financial Management Counseling Coaching for Homeownership Reverse Mortgage Counseling (coming soon) Homebuyer Education Workshop Post Purchase Workshops In addition, VCCDC also offers the following services. Please check those you are interested in. Mortgage Lending (purchase & refinance) Down Payment Assistance Realty Services For details regarding each of these services visit our website: www.vccdc.org Page 4 of 5
DECLARATION & AUTHORIZATION Please read the following statements and sign below to indicate you understand and agree to each statement. For simplification, the singular is used when the plural may apply. a.) I certify that all the information in this document and any attached documents are true and correct. I understand that withholding of information or giving false information will result in a refusal of my application. I understand that any intentional or negligent representation(s) of the information contained on this form may result in civil liability and/or criminal liability under the provisions of Title 18, United States Code, Section 1001. b.) I agree that VCCDC and its representatives shall not be liable, to the fullest extent provided by law, for any act or occasion related to or resulting from the evaluation or verification of the information contained in this document. c.) I acknowledge that with respect to the grant funds I shall have no further interest, right or claim. d.) I authorize VCCDC to verify the information within this application in order to certify my need for assistance related to the Thomas Fire and/or Montecito Mudslide. e.) If I am awarded a grant, I agree to: o Provide a brief statement describing how funds assisted me o Attend a Rebuilding Together ceremony where checks will be distributed o Sign a photo and/or story release for media purposes Signature: Date: Please see page 2 of this application packet for full submission details. FOR VCCDC USE ONLY Application Checklist NOTES Date Application Received: Application Received Via: Is Application Complete?: Confirmation of Receipt Sent to Applicant: Application Reviewed By/Date: Approval Status: Final Amount Approved: Applicant Notified of Decision/Date: Completed: Statement, Ceremony, Release Funds Distributed/Date: Page 5 of 5