Current Available Programs Application for Recovery Services Keeping It Cool Community Clean Up For more information about support possibilities. Personal Info Address of affected property Current Contact Address How may we help? General: Food Emotional/Spiritual Care COVID-19 Support Hurricane Michael Relief: Appliances Bill Pay Furniture Home Repair Storage/Moving Other (describe below) General Comments: Household Info Household Member 1 Injured? —Please choose an option—NoYes Household Member 2 Injured? —Please choose an option—NoYes Household Member 3 Injured? —Please choose an option—NoYes Add More Household Members Household Member 4 Injured? —Please choose an option—NoYes Add More Household Members Household Member 5 Injured? —Please choose an option—NoYes Add More Household Members Household Member 6 Injured? —Please choose an option—NoYes Add More Household Members Household Member 7 Injured? —Please choose an option—NoYes Add More Household Members Household Member 8 Injured? —Please choose an option—NoYes Add More Household Members Household Member 9 Injured? —Please choose an option—NoYes Add More Household Members Household Member 10 Injured? —Please choose an option—NoYes Other Info Answering any of the questions below will not disqualify you from consideration for assistance. Structure: —Please choose an option—Site-BuiltMobileRecreational VehicleCabinTransitionalMulti-family Insurance Coverage: —Please choose an option—StructurePersonal PropertyRenter'sNot Covered Elderly, Disabled, Veteran (select all that apply): ElderlyDisabledVeteran Income: —Please choose an option—Under $20k$21k-$45k$46k-$140k$141k-$200k$200k+