Disaster Financial Assistance Local Authorities' Registration Form

Note: In order to receive Disaster Assistance, you must be registered. Please submit this form within 90‐days of the implementation of the Disaster Assistance Policy for your area. We understand that, depending on your circumstances as a result of the disaster, you will not have access to some or all of the information that is asked on this form. Please fill it out to the best of your ability now, and a Pathfinder will follow-up with you to complete the form at a later time