Member Resources

CSCRC Disaster Relief Request Form

PLEASE NOTE: You must include photos with this application.



Personal Information










Physical Address (where damage occurred)












Mailing Address (if different from physical address)












I. Amount of Hardship Withdrawal and Description of Damage

You may request up to $1,000. The relief money should be used to repair damage to your primary residence or your personal property. If you suffered other economic harm, please explain.



Please describe in detail the way the relief money would be used.



* Required field