If you were affected by the [Disaster Name], fill out this short form to request help.
Scroll all the way down in the form, and press submit when complete.
The Disaster Intake Registry works with local partners to help people in Jackson and Josephine Counties during emergencies. If you have been impacted by [INSERT DISASTER NAME] and have unmet needs, please let us know by completing the form below. If your needs are urgent, you can also dial 2-1-1 for help locating resources in your community. Local resources and supports will be updated here: [insert link to resource page(s)].
Para ver este formulario en español, haga clic donde dice “English” y baje hasta encontrar “Spanish”. Si prefiere, en vez de llenar este formulario puede llamar al 1-833-669-0554 para hablar con alguien que escuche su situación y necesidades para ayudarle a conectar con recursos para recuperarse de los desastres.
WHAT HAPPENS NEXT
- Based on what you share, we’ll connect you with trusted community organizations that provide the type of support you need.
- If any details are missing, someone from our team may follow up to complete your referral.
- Your information is kept private and only shared with non-governmental partners directly involved in recovery services.