Apply for Services Employers Disaster Assistance Form If you are a Charlotte, Collier, Glades, Hendry or Lee county resident, let one of our representatives contact you about disaster assistance resources in your area. Name* First Last Current Business Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone:*Alternate contact number:Which is your preferred county for Disaster Employment?*Choose a locationLeeHendryGladesCollierCharlotteEmail* Enter Email Confirm Email Requesting the following services:* Need Workers Other Other: CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ Share this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to email a link to a friend (Opens in new window)MoreClick to print (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pinterest (Opens in new window)Click to share on Tumblr (Opens in new window)Click to share on Pocket (Opens in new window)
