Ross Fire 2026 Disaster Assistance and Reimbursement Request Form

Ross Fire 2026 Disaster Assistance and Reimbursement Request Form

Please provide details about your household, property, and expenses to help us assess your needs.
Disclaimer: request form funds is not a guarantee.
Full Name

First NameLast Name
Email Address
example@example.com
Date of Birth

MonthDayYear
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Address of damaged property

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How many people live in your household?
Please list the ages of all household members (separated by commas)
- Was your car damaged?
- Did you have insurance for the car?
- Are you the registered owner of the vehicle?
- What was the damage to your car?
- Vehicle Year
- Vehicle Make and Model
- What was your deductible? (USD)
- Are you seeking housing resources, financial assistance or reimbursement?
- What is your current housing status?
  
  Other
- Did you have homeowners or renters insurance at the time of the fire?
- Please describe the damage
- Please describe any out-of-pocket costs you have incurred due to the fire (e.g., repairs, temporary housing, supplies)
- Estimated total out-of-pocket expenses (in USD)
- Needs - Select all that may apply
- Please list all Assistance received
- Animal-related needs - select all that apply
  
  Other
- In your own words, what are your biggest needs at this time
- What do you see to be your biggest needs in the near future
- Is there any additional information you would like to provide?
- Should be Empty: