United Way 2-1-1 Disaster Intake Form

Only one disaster intake should be completed per physical address.  If you or someone in the household has already completed an intake online or by phone with 2-1-1, please do not complete an additional intake.













































Thank you for completing the United Way 2-1-1 Disaster Intake.  Your information will be shared with local Emergency Management Agencies and Community Organizations Active in Disaster (COADs).  

**Please note that 2-1-1 will not be able to provide any updates or make changes to your disaster intake form**