REQUEST FOR PUBLIC ASSISTANCE (RPA) – PRIVATE NONPROFIT ORGANIZATION

Request for Public Assistance - Private- Nonprofit

  • YYYY slash MM slash DD

  • APPLICANT PHYSICAL ADDRESS

  • APPLICANT MAILING ADDRESS

  • Primary Contact/Applicant's Authorized Agent

  • Alternate Contact

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  • QUESTIONS

  • FACILITY QUESTIONNAIRE

    (ALL RESPONSES RELATING TO THE FACILITY SHOULD BE WHERE THE EMERGENCY PROTECTIVE MEASURES (EPM) WERE PERFORMED).
    (CRITICAL - POWER, WATER, SEWER, WASTEWATER TREATMENT, COMMUNICATIONS, EMERGENCY MEDICAL CARE)

Note: The additional documents listed below are required and will be requested at a future date:

Tax Exemption Certificate
Organization Charter or By-Laws
Accreditation or Certification (schools or educational facilities)
Facility – Proof of Ownership
Facility – Legal Respoinsibility
Facility – Insurance