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Disaster Assistance Center Intake Form

  1. SCDEM Logo--thumbnail
  2. Disaster Assistance Center Intake Form
  3. *This form is designed to collect data to help the county address unmet needs, but is not a guarantee of assistance. Data collected will be used to help justify potential programs that may become available.
  4. Please check the box indicating you understand the statement on the left.*
  5. Primary Residence
  6. Was your home
  7. Do you
  8. Do you have homeowners/renters insurance?
  9. If you are not staying at your primary residence

  10. Do you have pets?
  11. Are they staying with you?
  12. Are they at the Spokane County Fairgrounds?
  13. food, supplies, place to stay...

  14. Leave This Blank:

  15. This field is not part of the form submission.