Grand Bahama Home Repair Request

Please fill out this application if your home on Grand Bahama was damaged by Hurricane Dorian and you are in need of services. Your information will be matched with local and international non-profit organizations who are providing mucking/gutting services, mold remediation, rebuilding, and vouchers for appliances and furniture. Completing this form does not guarantee services or goods.


First Name*
Last Name*
Age*
Gender*
Employment Status*
Marital Status*
Phone*
Alternate Phone No
Email Address
Preferred method of contact*
Phone Text Whats App Email
Contact preferred language*
English Creole Other

Damaged Home Address
Is damaged home inside the Freeport/Lucaya area?*
Yes No

Where do you currently reside (If different from damaged home address above) ?
Displaced in tent/structure in the yard
With relatives in Grand Bahama
With host family (not relatives) in Grand Bahama
Outside Grand Bahama but within The Bahamas
Outside Bahamas
How many other persons are in your household?*

Are there any persons with disabilities/special needs in your household?*
Yes No
What is the combined/total weekly income for your household (BSD)?*
No income $250 - $500 $501 - $750 $750 -$1,000 Over $1,001
Is the home owned by applicant or a family member (living or deceased)?
Yes No Unknown
Were or are you renting the damaged home?*
Yes No
Does applicant own other livable property?*
Yes No
Do you currently have a mortgage attached to the damaged property?*
Yes No
Did Hurricane Dorian damage your home?*
Yes No
How was your home damaged?*
Rising water/flooding
Roof damage
Ceiling leak
Other
Did you have flood insurance on your property?*
Yes No
What damages from Hurricane Dorian have you repaired on your home? Check all that apply:
Muck/Gut Mold Remediation Roofing Floors Foundational/Structural Walls Plumbing Electrical Ceiling Air Conditioning Units Doors Cabinets Other
Did you receive assistance from volunteers or non-profit organizations?
Yes No
What damages from Hurricane Dorian do you feel still need to be repaired in your home? Check all that apply:
Muck/Gut Mold Remediation Roofing Floors Foundational/Structural Walls Plumbing Electrical Ceiling Air Conditioning Units Doors Cabinets Other
Will you need furniture?*
Yes No
Will you need appliances?*
Yes No
Please tell us your story (optional):
Select Utility Bill type to upload*

Consent & Release

I hereby authorize The Grand Bahama Disaster Relief Foundation to share any of my information in its possession, including but not limited to my name, address, other personal information with other disaster relief and voluntary organizations in partnership with this system in order to coordinate potential disaster relief services and assistance. I understand that my information will be shared with participating members of the GB Home Repair working group in order to direct community resources. I understand that I may revoke this consent at any time by contacting The Grand Bahama Disaster Relief Foundation except when action has already been taken to obtain and/or release such information to member organizations of GB Home Repair working group. My acceptance on this release indicates that I have read the above, and that I understand the terms and conditions. I am also accepting this release on behalf of my children that are under the age of eighteen (18).


Completing this form does not guarantee services or goods.