NHRMC Employee Shelter Needs NHRMC Staff Storm Shelter Needs If you are a NHRMC employee who needs shelter from the impacts of Hurricane Florence, please fill out this form. We are working to identify resources to help members of our team in the wake of this storm. OK Question Title * 1. Name OK Question Title * 2. Where do you live? OK Question Title * 3. What type of damage does your home have? Flooding below level of receptacles Flooding above level of receptacles Structural integrity compromised Significant roof damage Other (please specify) OK Question Title * 4. How many people live in your house? OK Question Title * 5. Do you have pets that need shelter? Describe number and type. OK Question Title * 6. Does anyone in your house have special needs? Please describe. OK Question Title * 7. Do you have transportation? OK Question Title * 8. What is your email address? OK Question Title * 9. What is a phone number where we can reach you? OK Question Title * 10. Have you contacted FEMA (800-621-3362 or www.disasterassistance.gov) for assistance? Yes No OK DONE