Emergency Management Applicant Name Department of Military Affairs County Name Applicant Request for State Public Assistance Date Primary Contact Name, Title Mailing Address Phone Number E-Mail Address Damage Category Documentation A B C Type of Expense Damages (Time cards, Invoices, Cancelled Debris Protective Roads & Checks, Equipment Journals, etc.) Clearance Measures Bridges Labor Equipment Materials Contract Work Totals Applicants are encouraged to visit the WEM-WDF webpage to review the WDF Admin plan and the instructional to” video which explains how the should be organized with supporting “how “Toolkit” documentation. If an incorrect or incomplete document is submitted to WDF, it will be returned to the Applicant. Subsequently, the Applicant will be directed to the WEM-WDF webpage and will be encouraged to make contact with the WDF Coordinator to gain a better understanding of the program and how to submit a complete application package. WDF Coordinator: 608-242-3259 It is understood that the Applicant Documentation Toolkit and all supporting documentation will be submitted to the WDF Coordinator within 60 days of the disaster date. If an extension is needed, contact the WDF Coordinator. Typed Name of Chief Elected Official Signature of Elected Official Revised: December 2017
Emergency Management Applicant Name Department of Military Affairs County Name Applicant Request for State Public Assistance Date Primary Contact Name, Title Mailing Address Phone Number E-Mail Address Type of Expense Damage Category Damages Documentation (Time cards, Invoices, Cancelled Checks, Equipment Journals, etc.) A B C Debris Clearance Protective Measures Roads & Bridges Labor Equipment Materials Contract Work Totals Applicants are encouraged to visit the WEM-WDF webpage to review the WDF Admin plan and the instructional “how to” video which explains how the “Toolkit” should be organized with supporting documentation. If an incorrect or incomplete document is submitted to WDF, it will be returned to the Applicant. Subsequently, the Applicant will be directed to the WEM-WDF webpage and will be encouraged to make contact with the WDF Coordinator to gain a better understanding of the program and how to submit a complete application package. WDF Coordinator: 608-242-3259 It is understood that the Applicant Documentation Toolkit and all supporting documentation will be submitted to the WDF Coordinator within 60 days of the disaster date. If an extension is needed, contact the WDF Coordinator. Typed Name of Chief Elected Official Signature of Elected Official Revised: December 2017
Applicant_Request_for_State_Public_Assistance.docx