The Bay Improvement Group (BIG), a 501(c)3 not-for-profit organization that has been in existence for over 20 years, is working with other local groups and individuals to bring the needs of Sheepshead Bay residents affected by Hurricane Sandy to the attention of public and private sources of support, and to accelerate the pace of relief and recovery.

Please submit your answers to the following 10 questions about your household, so that we can include you in our appeals for specific supplies, volunteers, and other forms of aid and assistance.

In completing this form, you give BIG permission to contact you by phone and email, to share your information with organizations and agencies that may provide direct relief, and to include you in long-term recovery efforts.

For more information about Bay Improvement Group, please visit our website at, visit us on Facebook, or follow us on Twitter.

Thank you.

* 1. Please let us know who you are and how we can contact you.

* 2. Have you moved back into your home?

* 3. Please indicate the number of seniors, children, and persons with disabilities in your household, and the total number of people.

  1 2 3 4 5 6 or more
Number of seniors (age 62 or older) in household
Number of children under 18 in household
Number of persons with disabilities
TOTAL number of people in household

* 4. Please indicate the status of your home's utilities.

  Back on / repaired / working again Working partially but not complete yet Not back on/working, but repair work scheduled Not back on/working, and NO repair work scheduled yet Repair work will not be done
Hot water

* 5. Please indicate your home's demolition needs.

* 6. Have you seen mold in your home?

* 7. Have you registered with FEMA? (You must register with FEMA before you can register with Rapid Repairs. To register with FEMA, go to or calll (800) 621-3362. To register with Rapid Repairs, call 311.)

* 8. Please describe any critical/special needs you have right now that are not covered above.

* 9. If you have neighbors--especially ones who are elderly or disabled--who need urgent help, please provide the following:

* 10. What else is making it difficult for you to return to normal life and what kind of help do you need to address those challenges? Please be as specific as possible.