The Arc of Buncombe County Disaster Assistance Request Form
To request help, fill out the form below. Please do NOT share any sensitive information including your social security number in this form.
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please pick the county where you live.
Avery
Buncombe
Burke
Cherokee
Clay
Graham
Haywood
Henderson
Jackson
Macon
Madison
McDowell
Mitchell
Polk
Rutherford
Swain
Transylvania
Yancey
Other
Do you or a family member have an intellectual or developmental disability?
Yes
No
Uncertain
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Have you or your family been significantly impacted by Hurricane Helene?
Yes
No
What kind of assistance do you need? Please select all that apply
Emergency Housing (temporary housing)
Home Repairs
Relocation Assistance (help moving to a different place)
Utilities (electricity, internet, cell phones, etc.)
Transportation Assistance (help with your car, gas, or getting from one place to another)
Basic necessities (food, water, medicine, clothing)
Educational Tools/Resources
Laundry Expenses
Respite Care
Other
What is your greatest need?
Have you asked other agencies for help? Please indicate if you have received help.
We will be in touch about your request within 48 hours. Thank you for your patience.
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Submit
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