Disaster Relief Assistance Request form template
If you have been affected by a recent disaster, this form connects you to emergency assistance for housing, food, supplies, and recovery. We assess each household's needs and route you to the right resources as fast as possible. Verified residents can sign in to speed up intake. Help is available regardless of immigration status.
What’s in the box
Fast triage
A short needs assessment helps us prioritize the most urgent situations first.
Document once
Upload photos or documents of damage so caseworkers can act without delays.
Help for everyone
Assistance is available to all affected residents regardless of status.
Perfect for
- A family displaced by flooding seeking temporary housing
- A resident requesting emergency food and water
- A homeowner documenting storm damage for aid
- A senior needing help replacing lost medication
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Free forever for up to 1,000 submissions a month. No credit card.
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