Mosquito Fire Evacuees Educational Support Request
Use this form to request educationally-related supports and services for students and families affected by the Mosquito Fire.
Please note: THIS IS NOT AN EMERGENCY RESPONSE FORM. This form is only monitored Monday through Friday, 8:00am-4:30pm. 
For immediate assistance or assistance with emergency housing and food resources, dial 211 or visit

        Placer County 211: https://211connectingpoint.org/placer-county/ 
        El Dorado County 211: https://211eldorado.org/home/ 
 
For the most up-to-date information on the status of the fire, evacuation shelters, food resources, and more, please visit the Ready Placer site:  https://experience.arcgis.com/experience/07930e6e8f034ae4bba71e8bfedb2779/page/Current-Incidents/

For information on age-related reactions to trauma, visit: https://www.nctsn.org/resources/age-related-reactions-traumatic-event

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Email *
Contact information for person completing this form (email and/or phone number) *
Are you completing this form for yourself or on behalf of a family/student you are supporting. *
Impacted students name (list all students) *
What county does the student typically reside in (prior to the emergency/disaster)? *
Where does the student typically attend school? *
Required
If child(red) attends school not listed above, indicate school(s) name below:
Student(s) date(s) of birth *
Parent/Guardian/Caregiver's name(s) *
Parent/Guardian/Caregiver's phone number(s)/email(s) *
Current location or address of the student/family *
Current living situation *
Please select the support/service being requested *
Required
Briefly describe how we can help:
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