Emergency Network Los Angeles Agency Disaster Status Report
Email address *
Organization Type:Choose
Agency Name:
Contact Name:
E-Mail Address:
Site Address:
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.
Never submit passwords through Google Forms.
This form was created inside of Los Angeles Regional Food Bank. Report Abuse