Skip to content
Fire Disaster Impact & Relief Needs Survey
1.
Address
Name
ZIP/Postal Code
Email Address
Phone Number
2.
How are you connected to the Marina del Rey Rotary Club
3.
How have you been affected by the LA Fires?
Loss of property
Loss of employment
Displacement
Smoke damage
Other (please specify)
4.
Has your business, property, or home been damaged in the fire?
Yes, significant damage
Yes, minor damage
No damage
Not applicable
5.
Please share if/how family members and/or pets have been affected by the fires?
6.
Address of affected property if applicable
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)
8.
What specific items and or support do you need?
Send me a copy of my responses via email
