Recovery Assistance Request - Spring 2020 - Ottawa River Flooding 2019
This form is to gather information that will aid in identifying households that still require assistance in recovering from the Spring Floods 2019. Submission of information is not a guarantee that work will be done on your property. A representative will be in touch with you as soon as possible to discuss your ongoing needs.
Name *
Street Number *
Street *
Municipality *
Province *
Postal Code *
Phone Number *
E-mail
Structure Type
Clear selection
Primary residence?
Clear selection
Damage Description & Work Required
Disclaimer
Team Rubicon Canada strives to identify the reason for data collection, and
achieve the highest standard to data protection. In submission of this request, the
homeowner acknowledges that information and data disclosed in this form may be
shared with local governments, and other NGOs within the scope of the disaster
response. Homeowner information and data is required strictly for operational purposes
(for example, making contact with homeowners after the reception of an electronic
form). All information and data submitted via this electronic form will be destroyed at the
end of the disaster response.

Any questions about TRC's privacy policy can be sent to privacy@teamrubicon.ca .
*
Submit
Never submit passwords through Google Forms.
This form was created inside of Team Rubicon Canada. Report Abuse