DCM Intake Form
Eaton Fire Collaborative

Disaster Case Management (DCM) Assistance Request

If you were impacted by the Eaton Fire and need help connecting with Disaster Case Management (DCM), please complete this form. The Eaton Fire Collaborative will use this information to help connect you with an appropriate DCM provider or follow up regarding your existing case management services.

1
Identity
2
Request
Step 1 of 2 — Verify Your Identity

Enter the applicant's name and email. We'll search for an existing record and send a verification code to confirm their email.

No email address?

Step 2 of 2 — DCM Assistance Request

Please answer these questions about your Disaster Case Management services.

CONSENT TO FOLLOW UP & COORDINATE SERVICES

I consent to the Eaton Fire Collaborative collecting and using the information provided on this form for the purpose of helping me access Disaster Case Management services. I understand that the Eaton Fire Collaborative may contact me and, when necessary for coordinating DCM services, may contact or share this information with an appropriate Disaster Case Management provider or the agency I identified above.

Please choose one: *
No Problem — Complete by Phone

An email address is needed to verify identity online. If the applicant doesn't have one or prefers not to share it, a Disaster Case Manager can complete this intake with them over the phone.

Next steps for the applicant:

  1. Let a staff member or volunteer at this event know you'd like a phone intake.
  2. A case manager will follow up to complete the form with you by phone.
  3. If you're not at an event, contact the Eaton Fire Collaborative directly to be connected with a case manager.
Application Submitted

The DCM intake has been recorded and the applicant's master record has been updated where applicable.

Continue to the Full Dena Census →

Your verified information will be pre-filled as a starting point.