Hurricane Laura Intake Form

This registration form will assist United Way to assess the needs of Hurricane Laura evacuees.

 
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Primary Contact

You are required to have registered with FEMA. Please provide your FEMA number below, if you haven't registered yet, click here to register with FEMA

Enter every household member below

Household Member #1
Household Member #2
Household Member #3
Household Member #4
Household Member #5
Household Member #6
Household Member #7
Household Member #8

Lodging - Where are you currently staying?

Basic Needs

Please indicate which items you are in need of: