Emergency Assistance Reporting Form
Select Emergency Event
Date of Need
Demographic Info
Brother's Name
First
Last
Home Address
Address Line 1
Address Line 2
City
Arkansas
Louisiana
Oklahoma
Texas
State
ZIP
Displaced Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
ZIP
Mobile Phone Number
(Use 10 digit format, for example 5015559999)
Email
Fraternity Information
Other - Non 9th District Chapter
Alpha Delta
Alpha Delta Delta
Alpha Delta Epsilon
Alpha Delta Lambda
Alpha Delta Omicron
Alpha Delta Pi
Alpha Delta Theta
Alpha Iota Iota
Alpha Lambda
Alpha Mu Mu
Alpha Psi
Alpha Zeta
Beta Delta
Beta Sigma
Chi Delta Delta
Chi Kappa Kappa
Delta Eta
Delta Kappa Kappa
Delta Omicron
Delta Tau
Delta Xi
Epsilon Alpha
Epsilon Alpha Alpha
Epsilon Chi
Epsilon Iota
Epsilon Lambda Lambda
Epsilon Omicron
Epsilon Tau
Eta Chi
Eta Iota
Eta Kappa Kappa
Eta Lambda Lambda
Eta Mu
Eta Mu Mu
Eta Theta
Eta Xi Nu
Gamma Chi
Gamma Delta
Gamma Eta
Gamma Gamma
Gamma Lambda Lambda
Gamma Mu Mu
Gamma Omicron
Gamma Rho
Iota Gamma Gamma
Iota Kappa
Iota Rho
Kappa Chi
Kappa Zeta
Lambda Alpha
Lambda Chi
Lambda Kappa Kappa
Mu Beta
Mu Gamma
Mu Lambda
Mu Mu Nu
Mu Tau
Nu Delta Delta
Nu Iota
Nu Kappa
Nu Phi
Omega Beta
Omega Gamma
Omega Kappa
Omega Theta
Omicron Gamma Gamma
Omicron Lambda
Omicron Lambda Lambda
Omicron Nu Nu
Omicron Pi
Omicron Upsilon
Phi Beta
Phi Gamma
Phi Iota Iota
Phi Mu Mu
Phi Pi
Phi Psi
Pi Delta
Pi Kappa
Pi Lambda
Pi Omicron
Pi Sigma
Pi Tau
Pi Upsilon
Psi Alpha
Psi Upsilon
Rho Beta
Rho Beta Beta
Rho Chi
Rho Delta
Rho Mu
Rho Nu
Rho Omega
Rho Omicron
Rho Phi
Rho Theta
Rho Xi
Sigma Kappa
Sigma Lambda
Sigma Omicron
Sigma Sigma
Sigma Tau
Tau Epsilon
Tau Phi
Tau Sigma
Theta
Theta Alpha
Theta Chi
Theta Delta
Theta Kappa
Theta Mu
Theta Sigma
Theta Theta
Theta Upsilon
Upsilon Chi
Upsilon Iota
Upsilon Rho
Upsilon Theta
Xi Alpha Alpha
Xi Beta
Xi Delta
Xi Eta
Xi Omega
Xi Rho
Xi Sigma
Xi Upsilon
Zeta Eta
Current Chapter Affiliation
9-digit Control Number
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
12th
13th
District
If "Other" selected for current chapter, then type chapter here
Type of Assistance Requested
Prayer, Clean Up/Debris Removal, Shelter, Financial, Other
(If other, please explain)
Damage Assessment and Circumstances
If Financial Assistance is requested, check this box and fill out the corresponding info
Payment Method
Select Payment Method
Zelle
CashApp
Payment Handle
*** Enter 10-digit phone number or email if using Zelle
*** Enter cashtag starting with $ if using CashApp
