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Camper Winter Weatherization
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What is your name?
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What is your address?
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What is your phone number?
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What is your email address?
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Were you directly impacted by Hurricane Helene?
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No
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What size is your camper?
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Is you camper currently in a place where you can stay for the winter?
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Maybe
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Do you have access to power?
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No
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Do you have access to water?
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No
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Is your camper hooked up to sewage/waste disposal?
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No
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What condition is your camper in?
New
Good
Needs work
Serious issues (falling apart, mold, lacking insulation, etc)
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Do you have a case manager? If so, who are they, and with what organization?
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How did you hear about us?
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