Assistance for LA Wildfire Survivors of January 2025
This form is designed to gather information from individuals who are survivors of the January 2025 wildfires in Los Angeles or lost income as a result of the fire.

The information collected will help us collect data on survivors in need and if you qualify for supportive services, provide you with the necessary information,support and resources you may need during this challenging time.

We will review our forms on a weekly basis. Please allow 7-10 business days to review your form.
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Are you a survivor of the January 2025 LA wildfires? *
Please provide your full name. *
What is your contact number? *
Which area were you residing or working in before the wildfire? *
What is your email address?
What assistance do you need? (Select all that apply) *
Required
Do you have any specific needs or concerns we should be aware of? *
Do you have a specific need that were not reimbursed by FEMA or insurance? *
On a scale of 1 to 5; how urgent is your need for assistance? *
How did you hear about this assistance form? *
Please indicate any community organizations you are already in touch with. *
Required
Is there any other details you would like to share…
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