Clay County Disaster Housing Relief
In order to allow us to assist you, please fill in ALL questions with as accurate of information as you can. Any intake forms that are incomplete or that contain inaccurate information will be discarded.
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Full Name *
Your Phone Number *
Your Email Address
(if you do not have an email address of your own, please provide one through which we can communicate with you)
 *
Your current (or most recent) permanent address *
Are you 60 or over
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Do you have a place to go? Are you able to stay with family or a friend temporarily? *
Has Homeland Security or your landlord told you that your house is inhabitable?  *
Are you looking for short-term or long-term housing? *
Are you a homeowner or renter?
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Are you looking to buy or rent? *
Which surrounding towns are you willing to relocate to if necessary? *
Which counties are you willing to relocate to if necessary?
Do you have animals/pets? If so, how many and what kind? *
Do you need ADA accessibility? *
How many people are in your household? *
How many bedrooms will you need? *
What is your household gross monthly income?
Who is your employer? If not working, put none. *
What town do you work in? *
How many hours per week do the adults in your household work? (please add all hours worked by adults over the age of 18)
Will you need HUD assistance? *
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