MARC Assessment Form
The Madison Alliance for Rebuilding Communities is a group of community based organizations, non-profits, churches and residents who aim to work collectively on current Hurricane Helene recovery efforts as well as generate actionable solutions to help insure better community preparedness for future disasters. 

Please answer the following questions to the best of your ability and submit the form when finished. A member of our team will reach out to you soon to discuss the next steps. For more information or additional assistance, please email us at: support@madisonarc.org.
Name *
Do you live in Madison County? *
Pre-disaster address *
Current address if different from above
Please describe the reason you are seeking disaster-related support from the Madison Alliance for Rebuilding Communities. *
Was your home affected by the storm? *
Are you the homeowner? *
Current road condition to your home
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Do you currently have safe housing? 
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Have you recently applied, or are you currently working with, any of the following organizations? If so, please check all boxes that apply. 
Did you apply to FEMA? *
How would you prefer to be contacted? *
Are there any specific times or special requests for how we contact you? *
Cell Phone *
Secondary Phone Number
Email *
If the questions above do not cover your primary concern, please briefly describe why you are reaching out to us today. We will gather all the necessary details from you during the formal intake process soon.
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