Disaster Assistance Form

Applicant Contact Information*

Use the calendar to select year of birth, then month, then day. You can activate calendar by clicking in date of birth field.
Are you a Veteran?:


Authority: Authority to collect information for your disaster assistance application comes from Alaska Statute 26.23. Eligibility determinations are based on the State of Alaska Administrative Codes 6AAC 94.200 thru 6AAC 94.380 and 6AAC 94.900.

Eligibility to apply: Any resident with primary residence, transportation, and/or personal property damages. Any resident with medical/dental/funeral expenses as a direct result of the declared disaster. Person who is listed as the Applicant in this application will be the one receiving the grant funds.

Information Disclosure: Giving this information is voluntary; however, failure to give us the information may result in a delay or rejection of your request for disaster assistance. If other Government Assistance Programs (I.e. Small Business Administration) are available, applicants may be required to apply for them prior to receiving funds from the State Of Alaska Disaster Grant Programs. Information will be given to agencies from which you are seeking assistance. It may also be shared with insurers of your damaged property and with other disaster assistance providers to ensure you receive all possible benefits and to check for duplication. Federal Declaration: If a Federal Disaster is declared then this State application may be held in abatement and applicants may be requested to file an application with the Federal Emergency Management Agency (FEMA) and SBA.

Non-Discrimination Statement: State law requires disaster assistance be given in a fair and impartial manner, without discrimination on the grounds of race, color, religion, nationality, sex, age, handicap, or economic status. If you feel you have been denied assistance for one of these reasons, or if you have been discriminated against in any way, immediately contact the State of Alaska Division of Homeland Security And Emergency Management.