Wildfire Survivor Request for Assistance

Wildfire Disaster Relief Registration

Survivor Request for Assistance
What We Do

Totally Local VC's Local Love Project works to solve the immediate needs of those impacted by California disasters by providing items necessary to help our neighbors as they work to restore their lives.

For more information about the Local Love Project, go to LocalLoveProject.com.
Survivor Request for Assistance

Please fill out the form below completely
Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Affected address*

Street Address

Street Address Line 2

CityState

Zip Code
FullPartial
InsuredUninsured
Red Cross ID number
FEMA ID number
Driver's License
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Names and ages and clothing sizes of all household members*
List of pets and any pet needs*
List of IMMEDIATE or URGENT needs *
Wish list of other items needed*
Sources of assistance applied for or received
Other comments
Should be Empty: