Buncombe County Long-Term Recovery Group
Disaster Case Management (DCM) Intake and Self-Assessment Form

In the wake of Hurricane Helene, many in Buncombe County are facing long and challenging roads to recovery. The Buncombe County Long-Term Recovery Group (BCLTRG) is dedicated to ensuring that individuals and families receive the support they need to rebuild and thrive.

We are a coalition of local nonprofits, faith-based organizations, government agencies, and volunteers united to coordinate county-wide disaster recovery through intentional collaboration. Our efforts are guided by a commitment to equity and community resilience, ensuring that assistance reaches those who need it most. 

Please fill out the following form and we will follow up with next steps.
Disaster Address
Please enter the address of where you were living on September 27, 2024. This may differ from your current address.






Unmet Needs
In the section below, please select each self-identified disaster-caused unmet need that you or a member of your household have.

Please select each need one at a time and use the "Add another unmet need" button to add multiple. Please provide additional details on each unmet need.

For your reference, here is the full list of unmet needs to choose from:
  • Home repairs
  • Housing assistance
  • Rent assistance
  • Mold remediation assistance
  • Essential furniture and/or appliances
  • FEMA assistance
  • Personal property damaged
  • Utility assistance
  • Financial assistance
  • Food assistance
  • Transportation assistance and/or replacement vehicle
  • Employment support
  • Temporary storage of household items
  • Essential clothing
  • Healthcare assistance
  • Legal assistance
  • Behavioral health assistance
  • Functional needs assistance with services, devices, etc.
  • Assistance with pets/livestock
  • Funeral cost assistance
  • Other


 Please add the due date of you rent here and explain circumstances. If your landlord is pursuing eviction, include your landlord's name, email, phone:
What type of food?
Details of the above unmet need:
Based on your responses, you likely do not qualify for this program. Applicants must have been living in Buncombe County on September 27, 2024 and have at least one unmet need.
Eviction


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Hurricane Helene Survivor Information













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Current Address





Preferred Language





(For example, for safety reasons, do not leave a voicemail message or call after 6 pm. Or, “leave a message with any family member who answers.” etc.)
Communication Method



Communication Designee






Housing Situation at the time of Hurricane Helene








Current Living


Military Service

FEMA Registration




Household Members

For each additional household member, please provide:






Income Information




Special / At-Risk Populations



Health Insurance

Agency Support



Release of Information (ROI) Authorization
Release of Information (ROI) Authorization I authorize Buncombe County Long Term Recovery Group (BCLTRG) to share my personal and household information with agencies necessary to support my recovery.

Your application does not yet meet our selection criteria. Please double-check to ensure all required fields are completed.