Wildfire Recovery Assistance Application
Applicant Information
First Name
Last Name
Address
City
State/Province
ZIP/Postal Code
Email
Phone Number
Assistance Details
Type of Assistance Needed
Housing
Financial
Supplies
Other
Please describe your current needs
Property Impact
Describe Impact to Property
Were you evacuated?
Yes
No
Do you have insurance coverage?
Yes
No
Additional Information
Number of family members affected
Additional comments