Pre-Application
Please complete this form and a member of the Mountain Tough Recovery Team will reach out to schedule an in person appointment. This will help make your first visit to our office more efficient.
Email address
Name (Head of Household):
Your answer
Current Address:
Your answer
Current Phone:
Your answer
Pre-Fire Address:
Your answer
How many children in this household?
Your answer
How many adults in this household?
Your answer
Disaster Impact Questions
These questions will help your case manager learn more about how the disaster impacted your household.
Were there any changes to the household living situation as a result of the disaster?
Your answer
Did you rent or own?
Did you receive financial assistance from any of these organizations?
Required
Please list your current household income:
Your answer
Please choose the areas where you would benefit from assistance immediately:
Required
While you may have many needs at the present time, what is the biggest or most challenging need that you have?
Your answer
Appointment at Mountain Tough Recovery Team Office
All applicants will be assigned a case manager who will guide you through the recovery process. As a starting point, please choose a day that works best for you.
What is your preferred date for an appointment with a case manager? (Monday-Friday - 8:00 am to 5:00 pm)
MM
/
DD
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YYYY
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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