Emergency Network Los Angeles Agency Disaster Status Report
Email address *
Organization Type:Choose
Agency Name:
Contact Name:
E-Mail Address:
Site Address:
Zip:
Phone:
If your regular phone is not working, what is the best way to communicate with you?
Has your agency relocated?
Clear selection
If yes
Relocation Address:
Relocation Phone:
Relocation Fax:
Normal services offered:
Disaster services offered:
Agency problems not mentioned above:
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.
Problems or needs in your neighborhood? (for a general needs assessment):
A copy of your responses will be emailed to the address you provided.
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