OTG Response - Wildfires in Los Angeles County

Welcome to Off-The-Grid Missions (OTG) Request Form for assistance - Los Angeles County, Wildfires

OTG is providing essential relief supplies to the Deaf Community affected by the Wildfires in Los Angeles, California.

Please Note: Information is changing quickly. The more details you provide, the better we can understand your needs and explore how to help.
Name of Applicant*

First NameMiddle NameLast Name
Name of Caseworker or Person assisting you (optional)
If someone is helping you complete this form, please provide their name.
Phone Number*

Country CodeArea CodePhone Number
Communication Preference:*

VPFacetime / WhatsApp (Video)TextOther - please specify:
Email Address*
example@example.com
Address of Home, Shelter or Temporary Housing

Provide the location where you are right now, whether at home or after evacuating from your residence.
Please select one:

I am at my home, I have not been evacuated.I have evacuated to a shelter.I evacuated to a friend/family member's home.Other
Current Location - Street Address *
City*
State*
Zipcode*
Additional details about your current location (optional):
How many household/group members are with you?*
How many members under age of 12?*
Details about you and your family:*

DeafHard-of-HearingDeaf-BlindDeaf-DisabledCODAElderTemporary Disabled (due to an injury)Sign Language to Voice InterpreterCertified Deaf InterpreterWheelchair userHearingOther - please specify:
Current Situation:

Items are replacing lost items, aid is not guaranteed, please only select aid that has been damaged/lost, including sizes (for example, please do not request for items or sizes that you did not lose to the hurricanes).
Please select all that apply:*

I lost my home completely as a result of the wildfires.I evacuated and not sure about the status of my home.My home is not affected, but I've been evacuated.I need help with clothing, food, pet food, or hygiene care.Other
Anything else we should know?*
Photos or Short Videos (optional)

Cancelof
Agree to Terms & Conditions*

By submitting this aid request, I acknowledge that Off-The-Grid Missions (OTG) will review requests based on need and availability of resources. Completion of this form does not guarantee aid. OTG and its partners will use the information provided solely for internal review and prioritization.
Goods Not For Resale or Political Use*

I agree that goods donated by Off-The-Grid Missions shall NOT be offered for sale, sold, bartered, or used for any political purpose, or for the benefit or promotion of any political entity.
Date*

MonthDayYear
Date
I am at least 18 years or older.*

I am at least 18 years or older.
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Address of Home, Shelter or Temporary Housing

Current Situation: