Survivor Intake Form - EmergencyRV
This form will help us collect the information we need to add families to our waiting list for an RV. Please keep in mind we are a group of volunteers working as hard as we can to help as many people as we can. We may have to ask you to provide documentation to verify the information that you have provided so please be honest and truthful. All responses will be kept personal and confidential within EmergencyRV unless we get written consent from you to share your story.
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Name (first and last) *
Did you lose your home to a recent natural disaster?  *
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