Florida Keys residents in need of housing specifically due to Hurricane Irma
If you are among the displaced residents of Monroe County please complete this form as soon as possible.

This vital information will be used to acquire safe and dignified temporary and ultimately permanent housing for those in verified need. We understand that time is of the essence but please be patient. Our affordable housing problem is not new yet the post storm circumstances have made the crisis worse.

All of your responses are kept confidential and will ONLY be used to assist us as we seek appropriate accommodations on your behalf.

Email address *
Number of people in your household *
Your answer
Number of adults living in the home *
Your answer
Please tell us about these adults.
All of your responses are kept confidential and will ONLY be used to assist us as we seek appropriate accommodations on your behalf.
Do any of these adults have disabilities? *
If yes, please check all that apply.
Number of children living in the home *
Your answer
Please tell us about these children.
All of your responses are kept confidential and will ONLY be used to assist us as we seek appropriate accommodations on your behalf.
Do any of these children have disabilities? *
If yes, please check all that apply.
Number of senior citizens living in the home *
Your answer
Please tell us about these seniors.
All of your responses are kept confidential and will ONLY be used to assist us as we seek appropriate accommodations on your behalf.
Do any of these seniors have disabilities? *
If yes, please check all that apply.
Are there any current or former community helpers in your household?
If yes, please check all that apply.
Please tell us about your home.
All of your responses are kept confidential and will ONLY be used to assist us as we seek appropriate accommodations on your behalf.
Do you own or rent?
Please describe your home.
Please tell us about your living situation at this time.
All of your responses are kept confidential and will ONLY be used to assist us as we seek appropriate accommodations on your behalf.
Provide as many details about your displacement as possible. Check all that apply. *
Required
Where is your home? *
Please tell us how to reach you.
Remember, all of your responses are kept confidential and will ONLY be used to assist us as we seek appropriate accommodations on your behalf.
Name *
Your answer
Street address (where you usually live) *
Your answer
Telephone number *
Your answer
A copy of your responses will be emailed to the address you provided.
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