SGV Fire Relief Form

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As of 10/3/2025:

While we continue supporting households already in process, new requests for financial assistance , housing, and essential items will be referred to our partners in the Eaton Fire Collaborative. Please continue filling out the Fire Relief Request Form so we can track community needs and connect you with vetted partners. You may also reach out to the Eaton Fire Collaborative directly at www.eatonfirecollaborative.org.

Our case management, emotional wellness support groups, and Fire Relief resources/events remain fully available. Thank you for your patience. We are here for you and will continue to stand alongside our community.

With Community,

YWCA-SGV Fire Relief and Recovery Team

Name *

Email *

Phone Number *

Address (house that was affected) *

Are you filling this out on behalf of someone who's been affected? If so, who? (e.g., grandparent, mother, father) *

Do you have transportation? *

Yes

Which essential items do you need? Please select all that apply. *

Water

Towels

Gift cards

Suitcases

Air purifier

Full-sized lotions

Full-sized shampoos & conditioners

Comforter/Bedding

Durable Medical Equipment (e.g., cane or walker)

Clothing (i.e., Plus Size for women)

Adult disposable underwear (e.g., Depends)

Personal protective equipment supplies (e.g., gloves and face masks)

Maternity supplies (e.g., breast pumps, breast milk storage bags, or diapers)

Other:

Required

Do you need medication? *

Yes

You've selected yes to requesting medication. What type of medication do you need?

Tylenol

Advil

Aleve

Cough medication

Cough drops/lozenges

Antibacterial ointment

Nasal spray for allergies

Non-drowsy antihistamines for allergies

Antacids (e.g., Tums) for heartburn or upset stomach

Children medication (e.g., Tylenol, Motrin)

Eye drops for irritated eyes due to smoke/ allergens

Other:

Would you like to be connected to other resources at this time? Example: housing assistance, case management, senior services, or domestic violence services

If you would like to share your story with us, please do so. We are here for you and will support you the best we can.

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