LEAP Application - Fire/Weather Event

We are so sorry you're experiencing a crisis, and we are here to help! Please fill out this application as completely and accurately as possible to determine if you qualify for LEAP emergency assistance.

If you have any questions about LEAP or need assistance with your application, please contact Heather Johnson, LEAP Administrator, at 803-821-1288 or hyjohnson@lexington1.net.

Your Contact Information

Prefix (Mr., Mrs., Ms., Dr., etc.)

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Lexington One Connection * The field Lexington One Connection is required.

Work Site or School * The field Work Site or School is required.

School Year

Immediate Household

Please list all individuals who are permanent residents of the home, including yourself, spouse/significant other, children, etc.

Individual 1 Name * The field Individual 1 Name is required.

Individual 1 Relationship to Applicant

Individual 2 Name The maximum length for the field Individual 2 Name is 500 characters.

Individual 2 Relationship to Applicant

Individual 2 School & Grade (if child) The maximum length for the field Individual 2 School & Grade (if child) is 500 characters.

Individual 3 Name The maximum length for the field Individual 3 Name is 500 characters.

Individual 3 Relationship to Applicant

Individual 3 School & Grade (if child) The maximum length for the field Individual 3 School & Grade (if child) is 500 characters.

Individual 4 Name The maximum length for the field Individual 4 Name is 500 characters.

Individual 4 Relationship to Applicant

Individual 4 School & Grade (if child) The maximum length for the field Individual 4 School & Grade (if child) is 500 characters.

Individual 5 Name The maximum length for the field Individual 5 Name is 500 characters.

Individual 5 Relationship to Applicant

Individual 5 School & Grade (if child) The maximum length for the field Individual 5 School & Grade (if child) is 500 characters.

Individual 6 Name The maximum length for the field Individual 6 Name is 500 characters.

Individual 6 Relationship to Applicant

Individual 6 School & Grade (if child) The maximum length for the field Individual 6 School & Grade (if child) is 500 characters.

List anyone else not included above The maximum length for the field List anyone else not included above is 5000 characters.

Crisis Description

Please describe the crisis you experienced, including relevant dates. You also must submit documentation to the Educational Foundation from the authority handling your situation (e.g., fire incident report from the responding fire department, building inspector report, etc.) and proof of residence (e.g., utility bill).

Crisis Type * The field Crisis Type is required.

Loss Type * The field Loss Type is required.

How many people are in your household? * The numeric field How many people are in your household? is required.

Description of Crisis * The field Description of Crisis is required.

Authorization to Share Anonymous Information

With your permission, LEAP administrators may share an anonymous summary of your application to show the impact of contributions to the program. Your personal details will never be shared. Your response to this question will not affect the outcome of your application in any way.

I consent to LEAP sharing my story anonymously * The field I consent to LEAP sharing my story anonymously is required.

Signature

By providing my electronic signature below, I certify that all information in this application is true, accurate, and complete to the best of my knowledge. I am requesting emergency financial assistance due to an unforeseen event that has created a financial hardship for my household. I authorize the LEAP Administrator to verify any information to evaluate and process my application.

Electronic Signature (Full Name) * The field Electronic Signature (Full Name) is required.

Review and Submit

By submitting this application, you agree:

All information in this application is complete and accurate to the best of your ability.
Your application must be reviewed by a committee of Lexington One employees to determine eligibility. Your name and contact information will be removed, but all other information included in your application will be shared with the review committee members. They will keep your information confidential and will not discuss or share any information about your application with anyone except authorized LEAP administrators and review committee members.
Submitting an application does not guarantee approval or assistance.
You are required to submit supporting documentation by email (info@lex1edfound.org), mail or dropoff (702 North Lake Drive, Lexington SC 29072), or interoffice mail (LEAP - Educational Foundation).