Superstorm Sandy Assistance Notification Form

THIS FORM IS NOT AN APPLICATION FOR ASSISTANCE

By completing and submitting this Notification Form, you will be included in the New Jersey Department of Community Affairs’ (DCA) Superstorm Sandy Assistance Notification List. As Superstorm Sandy Assistance programs are announced, DCA will contact you with information on the programs themselves and how to apply. We will also update you when news announcements are issued based on the area of need you have specified.

For Businesses, if you are interested in Superstorm Sandy programs for your business needs, please complete the form on the New Jersey Economic Development Authority website at www.njeda.com. Click on Superstorm Sandy Information.

First Name *

Last Name *

Please enter the address, phone, and email that DCA should use to

contact you, NOT the address of your damaged property.

If you are not living in NJ, select "Out of State" for the County.

Current Living/Mailing Address (Number and Street or PO Box) *

County *

Municipality (City, Town, Township) *

State *

Zip Code *

Phone *

Email *

Confirm Email *

I am a... *

Other

For additional information on housing and community resources programs

visit the NJ DCA website.

THIS FORM IS NOT AN APPLICATION FOR ASSISTANCE

Homeowner	Tenant	Landlord/Developer
Local Government Official	Construction Contractor	Non-Profit Organization
None of these (describe below)