KLX Disaster Relief Fund

APPLICATION FOR PRESIDENTIALLY DECLARED DISASTERS

This Fund helps qualified KLX employees or contingent workers in the US (who have been staffed exclusively with KLX through an agency for a minimum of 5 years) who have experienced a presidentially declared natural disaster and, as a result, cannot afford housing, necessary utilities or other basic living needs.

ELIGIBILITY: All KLX Inc. (the “Company”) employees who are 1) currently regular full-time or part-time employees, 2) active or on approved leave of absence for no more than one year, and 3) employed at the time of the disaster are eligible. If the employee has passed away, then a family member or approved representative may apply on behalf of the family.

To check your area's status, go to www.fema.gov 

Community Foundation staff is available to assist all applicants with this process. Email EmergencyGrants@cfmt.org or call 615-321-4939 with questions.

Do You Qualify?

To qualify for this program and receive assistance you must meet all of these requirements:

If you do not meet one of the requirements above, please send an email to EmergencyGrants@cfmt.org or call 615-321-4939 to discuss your situation with a member of our team.

Contact and Employment Information

Name*
Is it okay for us to contact you through this email address?
Address 1*
Can you currently receive mail at this address?*
Alternate Address
Is it okay for us to leave a message for you at this number?
Is it okay for us to leave a message at this number?

Describe Your Situation

(e.g. hurricane, tornado, flood, storm etc.)
Date of the incident*
Enter the date of the incident that is causing your financial difficulty.
Describe your housing arrangement at the time of the disaster*
Is your rental payment made to:
Are you responsible for any repairs to your rental property?*
Damage to the outside or structure of your home - check ALL that apply
The Fund cannot pay to repair other property such as fencing, carports, garages, or storage buildings.
Damage to the inside of your home
Damage or loss of your belongings - check ALL that apply
The Fund cannot pay to replace non-essential items, such as electronics.
Clothing and personal items
Is the damage to your vehicle covered by insurance?*
Have you been displaced from your home?*
Where have you stayed away from your home?
What kind of documentation or paperwork do you have that shows your losses?
Have you lost power or other utility services at any point?*
Which essential services have been out?
Have you registered for assistance with FEMA?*
This will not affect assistance you receive from this program.
Do you expect insurance of any kind be used to cover your losses?*
Type of Insurance?
Tell us more about how insurance will be used to cover your losses
Tell us about what won't be covered
Please include only information from the past 60 days if possible.
Your absences may be verified with your employer
How many unpaid days of work have your or other wage-earners in your household missed?

Documentation

You will need to submit documentation that reflects the impact of this disaster on you and your household.


There are different types of documentation that you can send. Choose the option that is easiest for you.

  • You can send photographs. Please make sure that photos show the damage clearly.
  • You can submit a report from your insurance company if it describes the damage and estimates the loss.
  • You can send FEMA paperwork (if you have it) that details the damage or loss.
  • Documentation can be sent separately from your application. Include your name with every item that you send so that it can be matched with you application.

Upload the relevant files below or send them by email to EmergencyGrants@cfmt.org with your name in the subject line.


Once you upload your first document, you will be given an option to upload additional items.

Are you uploading documentation through this form?
No Assistance can be given until adequate documentation is received

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Assistance Grants

The maximum allowable grant amount is $5,000. Not all applicants will receive the full amount, and no specific grant amount is guaranteed.

The total grant amount awarded to each applicant varies and is based on your documented financial impact, hardship, and demonstrated need.

Once approved, a member of our team will contact you to confirm the best way to provide you with assistance.

Agreements and Acknowledgements

No employee is entitled to receive a grant, either by their employment, their history of contributions to the Fund or because of any precedent inferred from a previous grant from the Fund. Grants will not be made before an applicant has demonstrated an immediate financial need and provided all required documentation.

This application will be treated in a confidential manner by The Community Foundation of Middle Tennessee; however non-identifying statistical information will be reported to the Company on a periodic basis.

Employees are expected to provide truthful and accurate information. In its due diligence, if The Foundation discovers any information to be untrue, it shall have the right to unilaterally waive its confidentiality and report its findings to the Company. The fiduciary expectations of all employees are paramount and a breach of these standards will be reported to your employer.

Your signature below certifies that the information provided is true and complete, authorizes The Community Foundation to obtain and/or verify all information necessary to process this application, and releases the Company and The Community Foundation of Middle Tennessee from any liability associated with the rejection of or funding of this application. Remember the total grant amount available for assistance varies and is based on each applicant’s documented financial impact, hardship, and demonstrated need. No award amount is guaranteed, as each case is evaluated individually according to the program guidelines In addition, you agree to provide the requested documentation supporting the information provided.

Acknowledgements*
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