Fire Disaster Impact & Relief Needs Survey

Question Title

* 1. Address

Name

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. How are you connected to the Marina del Rey Rotary Club

Question Title

* 3. How have you been affected by the LA Fires?

Loss of property

Loss of employment

Displacement

Smoke damage

Other (please specify)

Question Title

* 4. Has your business, property, or home been damaged in the fire?

Yes, significant damage

Yes, minor damage

No damage

Not applicable

Question Title

* 5. Please share if/how family members and/or pets have been affected by the fires?

Question Title

* 6. Address of affected property if applicable

Question Title

* 7. What type of relief support is most critical for you right now? (Select all that apply)

Emergency shelter

Food and water

Financial aid

Mental health services

Pet care

Clothing and personal items

Property recovery and repairs

Other (please specify)

Fire Disaster Impact & Relief Needs Survey

Question Title

* 1. Address

Question Title

* 2. How are you connected to the Marina del Rey Rotary Club

Question Title

* 3. How have you been affected by the LA Fires?

Question Title

* 4. Has your business, property, or home been damaged in the fire?

Question Title

* 5. Please share if/how family members and/or pets have been affected by the fires?

Question Title

* 6. Address of affected property if applicable

Question Title

* 7. What type of relief support is most critical for you right now? (Select all that apply)

Question Title

* 8. What specific items and or support do you need?