2. First Name
3. Last Name
5. Mailing Address of Homeowner
7. City
8. State
9. Zip
11. Phone
13. Email Address
17. Address of Home Seeking Mitigation Funding, if different from above
19. City
20. State
21. Zip
23. Parcel number, if known
25. Brief Description of Past Disaster Impacts
27. Please check which options would you be interested in pursuing or learning more about?

    1. Elevate or reconstruct home above minimum flood elevation to code requirements.
    2. Sell out property.
29. Has homeowner participated in home mitigation programs in the past for the property seeking mitigation funding listed above?

    1. Yes
    2. No
31. This survey form does NOT obligate the homeowner or the County to participate in any grant programs. The County will communicate future grant program opportunities to homeowners who may choose to participate or not participate in the program at that time. This form is for survey purposes only to identify interested homeowners.
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field