Emergency Assistance
For those needing financial assistance who have been affected by Hurricane Ian / Para aquellos que necesitan ayuda económica que han sido afectados por  Huracán Ian
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Email *
What is your first and last name? / Cuál es su primer nombre y apellido *
What is a number that we can reach you? / A qué número podemos contactarlo? *
Number of people in your household / Número de personas que viven con usted *
What county do you live in? / En qué condad vive? *
How did you hear about this program? / Cómo escuchó de este programa? *
Have you experienced financial hardship as a result of Hurricane? / Ha vivido dificultades económicas como resultado del Huracán Ian? *
Please explain in 1-3 sentences how you have been affected. Por favor explique en 1-3 oraciones cómo usted fue afectado *
What type of assistance are you seeking? Qué tipo de ayuda está buscando? *
Do you have a deadline in which you need this assistance? Tiene una fecha límite en que necesite esta ayuda?
A copy of your responses will be emailed to the address you provided.
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