Apply for Assistance

Reno County Wildfire VOAD Intake Assessment

After you complete your assessment, a member of the United Way of Reno County team will review your application.
Upon review, you will be contacted. Please ensure your contact information in this form is accurate. If you do not hear from a representative within 48 hours of submitting the form, please contact the United Way of Reno County at 620-669-9329.

Assessment Form

Reno County Wildfire VOAD Intake Assessment

Your Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Housing
Do you have a place to stay temporarily?*
- Yes
- No
Number of Household Members*
Name Relationship DOB
Are you the homeowner?*
- Yes
- No
Insurance*
- Yes
- No
- N/A
Do you lease?*
- Yes
- No
What is your landlord's name?
First Last
Rental insurance?*
- Yes
- No
- N/A
Do you need help with identification documents?
- Driver's licence
- Birth certificates
- Deeds
- Social Security cards
- Other
Check all that apply.
Other
If you selected "Other" above, please list document needs.
Immediate Needs
Clothing (sizes)
Shoes (sizes)
Transportation
Food
Medications