Hurricane Ian - Unmet NeedsRequest For Information

Hurricane Ian - Unmet Needs

Request For Information

Which of the following choices best describes what information you are seeking:*

Business

Individual

Private Nonprofit (PNP)

Please provide us with the Business Name*

Please provide us with the Profit Non-Profit (PNP) name*

First Name*

Last Name*

Street Address*

City*

Zip Code*

County*

Select

E-mail Address*

Phone Number*

Phone

Preferred Language

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Do you have one or more critical needs as a result of Hurricane Ian that are currently not being met?**

A critical need means items that are necessary for maintaining or sustaining life, such as shelter, drinking water, food, medicine, and medical care

Yes

Would you like to receive information in any of the following services

Food and Nutrition

Access and Functional Needs (AFN)

Emotional Support Resources

Other

Please provide more detail on the critical need(s) you have that is/ are currently not being met*

Select

What describes your housing/living situation prior to Hurricane Ian?*

Select

Has your home flooded as a result of Hurricane Ian*

Select or enter value

Have you or a member of your household experienced life-changing events as a result of this disaster? Check all that apply. If none apply, skip this question*

Select or enter value

Does anyone in your home have a disability or other access and functional needs?*

Yes

Please provide more information on your critical needs that are not being currently met

Please provide the name of the program you are seeking information on

Have you already applied for FEMA Assistance?*

If you have not yet applied for FEMA Individual Assistance and would like to apply, please visit https://www.disasterassistance.gov/.

Yes

Please provide your 9-digit FEMA Registration number*

Please provide additional information regarding your critical needs that are currently not being met*

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