We are so sorry that you suffered from the floods on September 4, 2022.

Our goal is to help get you the relief you need.

Please, fill out this form completely and honestly.

This is a needs assessment. It does not guarantee funding.

Thank you for providing the information we need to do our job.

* Please, CHECK ALL THAT APPLY to you and your situation relating to the floods on September 4, 2022.
* Please, briefly describe your situation, such as "my house/business took in 10" of water", "I lost 50% of my inventory", etc...
0/500
Please rank the following from 1-5, with 1 being the MOST IMPORTANT to you. This is not a required question.
* What is your contact information? Please list name, address of property, and the best phone number to reach you.
0/500
* What is the estimated total in losses you had due to the flood on September 4, 2022?
0/500