• Donate
  • Facebook
  • Twitter
  • LinkedIn
  • Programs & Services
    • Adoption
    • Pregnancy Options Colorado
    • DIRA Scholarship
    • Disaster Response
    • Foster Care
    • Family Support & Education
    • Immigration Legal Services
    • Lifework Aging Solutions
    • Refugees & Asylee
    • Pamoja Early Childhood Workforce Program
    • Road to Economic Freedom Employment Program
  • Locations
  • Get Involved
    • Events & Trainings
    • Fundraising for LFSRM
    • Volunteer
    • Refugee & Asylee Volunteer Program
  • Employment
  • Give Now
    • Donate
    • Fundraising for LFSRM
    • Planned Giving
    • Tax Statement
  • About Us
    • Leadership
    • Partnerships
    • Annual Reports & 990’s
    • Board of Directors
    • Board of Trustees
HomePrograms & ServicesDisaster ResponseMarshall Fire and Wind Event ResponseMarshall Fire Wind Event Screening Form
Share

Marshall Fire/Wind Screening

Primary Contact Name(Required)
Secondary Contact Name

Household Information

Are there persons in the household with: (check all that apply)(Required)

Current (Post-Disaster) Address/Living Situation

Are you in stable and secure housing?(Required)
If yes, list address:(Required)
Do you have ALE Insurance - Additional Living Expenses?(Required)
Date ALE expires:(Required)

Employment

Are you currently employed?(Required)
Did you lose wages and/or your employment due to this disaster?(Required)

Other Immediate Urgent Needs As Result of the Marshall Fire

Please check all that apply:(Required)
Are you receiving regular case management from any other agency at this time?(Required)

Pre-Disaster Address and Situation

Pre-disaster Address(Required)
Did you own or rent?(Required)
If rebuilding do you need information regarding funding sources?(Required)
If rebuilding has permit been applied for?(Required)
Have you registered with FEMA?(Required)
Do you need to continue with FEMA?(Required)
Have you applied with SBA?(Required)
Are you continuing with SBA?(Required)

Insurance

Do you have insurance?(Required)
Has insurance settlement been received?(Required)
Do you want assistance with your recovery plans?(Required)

Marshall Fire/Wind Screening

Primary Contact Name(Required)
Secondary Contact Name

Household Information

Are there persons in the household with: (check all that apply)(Required)

Current (Post-Disaster) Address/Living Situation

Are you in stable and secure housing?(Required)
If yes, list address:(Required)
Do you have ALE Insurance - Additional Living Expenses?(Required)
Date ALE expires:(Required)

Employment

Are you currently employed?(Required)
Did you lose wages and/or your employment due to this disaster?(Required)

Other Immediate Urgent Needs As Result of the Marshall Fire

Please check all that apply:(Required)
Are you receiving regular case management from any other agency at this time?(Required)

Pre-Disaster Address and Situation

Pre-disaster Address(Required)
Did you own or rent?(Required)
If rebuilding do you need information regarding funding sources?(Required)
If rebuilding has permit been applied for?(Required)
Have you registered with FEMA?(Required)
Do you need to continue with FEMA?(Required)
Have you applied with SBA?(Required)
Are you continuing with SBA?(Required)

Insurance

Do you have insurance?(Required)
Has insurance settlement been received?(Required)
Do you want assistance with your recovery plans?(Required)
  • Facebook
  • Twitter
  • LinkedIn

Adoption

  • Infant Adoption
  • International Adoption
  • Designated Adoption
  • Pregnancy Options Colorado
  • ICPC
  • Waiting Families
  • Matched Families
  • Search & Reunion
  • Affording Adoption

Disaster Response

Foster Care

  • Foster to Adopt
  • Foster Care FAQs
  • Contact Us

Family Support & Education

  • KPC Respite Center
  • Parenting Education
  • SafeCare Colorado
  • SafeTouch
  • Visitation & Safe Exchange

Refugee & Asylee

  • Refugee Volunteer Resources
  • Refugee & Asylee Volunteer Program
  • Refugee FAQs
  • Employ Refugees
  • Pamoja Early Childhood Workforce Program

Lifework Aging Solutions

© 2023 Lutheran Family Services Rocky Mountains
  • Privacy Policy
  • Sitemap
  • Contact
Website by Blackbaud
EN
ES EN