Disaster Relief Request Form

In order to better assist those who are affected by natural disasters in Eastern Oklahoma, this form will give us the information needed to serve to those in need.
  • Please list the address of the residence affected by disaster.
  • Please list two phone numbers where you can be reached.
  • Please list the names of other agencies who have already assisted you and what assistance those agencies have provided.
  • Please list any other information that may help us serve you better.