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 money may be used to repair damage to your primary residence, to pay your car insurance deductible, or for living expenses (hotel, transportation) if you were forced to leave your home due to the damage or an evacuation. There may also be funds available for rental assistance if you have had to relocate. Please include copies of any estimates, receipts, insurance information, or leases/rental agreements.



Please describe in detail the way the money will be used given the above guidelines



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