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Inspire Hope Furniture Request Form

Adventist Health’s Inspire Hope Project serves as a local redistribution center, assisting our nonprofit partners with items aimed at improving the quality of life for people they serve. The service is possible due to our partnership with World Vision, an international nonprofit that connects businesses who have goods with charities that need them. Our Inspire Hope Project is a collaboration between local partners working disaster recovery, who can ensure the goods are given to families and individuals with the greatest need. The Adventist Health Love Gives Program, Magalia Community Church, and Paradise Hope Center are among some of the partners involved in distributing these donated goods. By filling out this form, you are agreeing that any donations you receive will be used toward your recovery and will not be bartered/traded/sold. Inspire Hope and its partners are not responsible or liable for the transportation, loading, and/or delivery of goods. Please be prepared with ample assistance and transportation to pick up your donations. 

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Email *
Please share a little bit about how life has been for you and your household since the fire.  *
How will these requested items help you? (For example: beds so that we no longer sleep in the floor, or fixtures to offset rebuild expenses).  *
What would be the one thing (item) that would make the most positive impact on you and your family?  *
What has helped you so far with your recovery journey from the fire? This can be a resource, a wellness, practice you have found, an organization, etc. Share anything that has helped you with your recovery.  *
First Name *
Last Name *
Street Address *
Town/City *
Required
State *
Zip *
Phone Number *
What is your annual household income?  *
Prior to the fire, how long had you lived at your residence?  *
Which fire were you impacted by?  *
If you were not impacted by a fire, please explain. 
How many members live in your household?  *
Ages of people in your family, including you? Check all that apply.  *
0
1
2
3
4
5
6
0-17
18-30
31-40
41-50
51-60
61-70
70+
Are you a veteran?  *
Are you currently living in the burn scar?  *
What best describes your pre-disaster living situation?  *
What is your current living arrangement?  *
Do you have a disaster case manager?  *
Would you like for us to refer you to disaster case management with the information you provided in this form?  *
I am interested in furniture items (couch, chairs, dining room table, etc.). *
Required
I am interested in appliances (washer, dryer, refrigerator, etc). *
Required
I am interested in household items (air fryer, toaster, crockpot, etc). *
Required
I am interested in fixtures (faucets, handles, lighting, doorknobs, etc.). *
Required
Are you looking for something specific or an item not described above? Please let us know what you are trying to find.  *
I consent to my picture being taken *
The information I have reported in this form is accurate and correct.  *
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