Fire Survivor Heating Assistance Application

To Qualify for Heating Assistance, applicant must show proof of completed HEAP application.

Those who suffered total loss are eligible for up to 1/2 cord of firewood, and a heater with one fuel refill.

Those who did not suffer total loss, are eligible for 1/2 cord of firewood with one heater.

Assistance will be provided based on demonstrated need. Preference will be given to those enrolled in the Disaster Case Management Program who lost their home, to those with disabilities, and to the elderly. Applications will be accepted through 11/30/22; the next round of assistance will be available in January 2023.

For any questions, please contact Regina Moffet, Coordinator, Dixie Fire Resource Center.

email: rmoffet@plumasruralservices.org

Phone: (530)283-2735 ext. 833
Name*

First Name Last Name
Date of Birth*

MonthDay Year
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Is this an emergency heating situation where you are now without heat or where you will be without heat in the next 3 days to one week? If yes, please describe.*

YesNo
Was your property damaged or destroyed?*

Completely destroyedDamagedUndamaged
Current Physical Address:*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Is your mailing address the same as your current physical address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please list all household members below. (first name, last name, relationship to applicant, age)*
What is the main source of fuel that you use to heat your home?*

ElectricityWoodPropaneFuel OilKeroseneOther Fuel
What is the second source of fuel you use to heat your home?*

ElectricityWoodPropaneFuel OilKeroseneOther Fuel
How long until you run out of fuel to heat your home?*
Can you arrange for a vehicle to come to Crescent Mills to pick up the resource(s) you need?*

YesNo
Comments or questions should be written in this section:
Please do not call the resource center about firewood. We have a high call volume. Limit one application per household.
Should be Empty: