Pisgah Legal Services FEMA Assistance

What first name should we call you?

Last name

Date of birth

Type of phone

Phone number

Email address

If no email, use format fakefirstlast@fake.com, e.g. fakemarysuarez@fake.com

Number of people in household (People applying for assistance on one application)

Full name of PLS staff or volunteer

Appointment location (Phone OR location of clinic)

Did you make a referral to the Disaster Response Team (DRT)? You can make a referral by emailing drt@pisgahlegal.org.

Appointment notes

I understand and agree that assistance from Pisgah Legal Services in completing my FEMA Individual Assistance application is not a legal consultation and does not create an attorney-client relationship between myself and PLS. I understand that communications with PLS staff in the process of completing this application are not confidential or privileged under the NC Bar's Rules of Professional Conduct.

Yes, I agree

I certify that the information I am providing in my application is true and correct to the best of my knowledge. I understand that Pisgah Legal Services staff and/or volunteers can only assist me based on the information I provide. I acknowledge that my FEMA Individual Assistance application is and remains my responsibility.

Yes, I agree