January 2025 Wildfires Disaster Relief​ Financial Assistance Application

The UFLAC is here to help you recover after a disaster.

By submitting this form, we will consider you for financial assistance. The UFLAC will contact you using the information you provided on the form below.

January 2025 Wildfires Disaster Relief​ Financial Assistance Application

Name and Contact Information

First
Last

Pre-Disaster Address

Street Address
Appartment / Unit Number
City
State/Province
Zip/Postal

Current Address

Street Address
Appartment / Unit Number
City
State/Province
Zip/Postal

Household Members

What assistance do you need?

Check all that apply.

Property Damage
Emergency Needs
Other Expenses