Need Help Now – Request Assistance Form

Help USA Homes is committed to supporting communities impacted by disasters. If you or someone you know is in need of assistance due to a disaster, we are here to help. Please complete the form below with accurate details so we can assess your needs and provide the necessary support as quickly as possible.

Assistance to Communities

At Help USA Homes, we are dedicated to providing immediate and long-term relief to communities devastated by disasters. Every year, millions of families are impacted by natural and man-made disasters, losing their homes, businesses, and sense of security. Our mission is to respond quickly and effectively to these crises, but we can’t do it alone. We need your help now to continue providing life-saving assistance to those in need.

Emergency Disaster Relief Assistance Form

Once submitted, your information will be reviewed, and our team will contact you to confirm the next steps for providing the necessary support.

Please provide the following information to help us assist you:

Need Help Now

First Name

Last Name

Numeric Field

Address

City

State

Zip Code

Country

Disaster Information

Location of Disaster (Please select the affected area):

Date of the Disaster:

Type of Disaster:

Textarea

Needs Assessment

Please select the type of assistance you are requesting.

Shelter Assistance (Temporary housing, shelter)

Food and Water Assistance

Medical Assistance

Clothing and Personal Care Items

Rebuilding Assistance (Home or business restoration, materials, labor)

Financial Support (Temporary assistance for daily expenses)

Pet Care and Shelter

Other Assistance Needed

Textarea

Additional Information

Number of People in Household (Including children and elderly):

Do you have any special needs or disabilities (e.g., mobility, medical needs)?

Do you have any pets or animals that need immediate care?

Please provide any other relevant information that will help us better serve you:

Consent to Receive Assistance: By submitting this form, I consent to receiving assistance from Help USA Homes and understand that the information provided will be used to assess my needs for disaster relief services.

I agree to the terms and conditions.

We need your Support!

Your support is urgently needed to provide life-saving aid and rebuild communities after these devastating disasters. Together, we can ensure that no one is left behind.

Click here to donate or sign up as a volunteer.

Help USA Homes is here to serve and respond to the immediate needs of disaster-affected communities. Your generosity and involvement can help save lives and restore hope.