Disaster Relief Request Form

Dodge County Disaster Relief Request Form

Lions District 27-A2
Dodge County, WI was significantly impacted by 6 tornados on May 15, 2025. With financial support from Lions Clubs International, our local Lions Clubs are able to provide support to impacted families.
The plan is to have the items ready for distribution around June 6, 2025. Once this request is entered, Lions will shop for the items and contact you with any questions or to arrange pick up/drop off. We cannot guarantee any particular items, but we will do our best to fulfill all requests. We also cannot provide cash, gift cards, or payments for rent or down payments.
Which Lions Club is closest?*
Were you directly affected by the Tornados?*

YesNo, I'm requesting for someone elseNo, I represent a company/organization
Your Contact Information*

First NameLast Name
Impacted Person's Name*

First NameLast Name
Your Phone Number*

Area CodePhone Number
Impacted Person's Phone Number*

Area CodePhone Number
E-mail*
Preferred Method of Contact

TextEmailPhone Call
Impacted Address*

Street Address

Street Address Line 2

CityState

Zip Code
Are you living at a different address?

YesNo
Temporary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please indicate the quantity next to the item(s). We will do our best to provide the items requested. Please Note: We also cannot provide cash, gift cards, payment for rent or down payments, and funds towards repairs of homes or vehicles.
Immediate Needs
Toiletries (List Quantities)
First Aid Supplies (List Quantities)
Home Goods (List Quantities)
Cleaning Supplies (List Quantities)
Infant Care (List Quantities)
Clothing (List Quantities and Sizes)
Footwear Condition (List Quantities and Sizes)
What are your food needs?
Any food allergies?
Please list other support needed and we will do our best to help find resources.
Should be Empty:

Dodge County Disaster Relief Request Form