Application for Assistance

Application for Assistance

July 6, 2026 Becker County Storm
There is no guarantee of assistance. But filling out this form will help MAHUBE-OTWA and Becker County put limited donations to the best use.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address of the storm damage if different than the address listed above.
What amount of financial assistance are you seeking?
What is your greatest need?

Other
Describe your need for financial assistance due to the July 6 Becker County storm.
Describe your relationship to the impacted property (check all that apply)
Do you have homeowners or renters insurance and if so have you filed a claim?
List other disaster assistance you've applied for related to the July 6 storm and whether it has been received, pending, or denied/
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are there factors that should prioritize your application (check all that apply)

Other
Date of Birth

MonthDayYear
Date
List household members and their ages
I certify this information is accurate and consent to the information being shared with MAHUBE-OTWA and Becker County.
Signature
Should be Empty: