Emergency Network Los Angeles Agency Disaster Status Report
Email address
Organization Type:Choose
Agency Name:
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Contact Name:
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E-Mail Address:
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Site Address:
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Zip:
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Phone:
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If your regular phone is not working, what is the best way to communicate with you?
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Has your agency relocated?
If yes
Relocation Address:
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Relocation Phone:
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Relocation Fax:
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Normal services offered:
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Disaster services offered:
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Agency problems not mentioned above:
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Does your agency have needs you want to communicate to other ENLA agencies? (This information is used to conduct a general needs assessment; there is no guarantee that assistance can be offered. DO NOT request emergency or governmental assistance on this form.
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Problems or needs in your neighborhood? (for a general needs assessment):
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A copy of your responses will be emailed to the address you provided.
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