SE Mich Recovery Coordination Center Flood Cleanup Intake Form
The Michigan Community Service Commission is coordinating volunteers through a Recovery Coordination Center to provide clean-up assistance to those still in need from the floods. If you need assistance in removing flood-affected belongings, mud, sand, or floodwater, gutting flood-affected walls (drywall/paneling) or disinfecting your house, volunteer organizations may be able to provide volunteers to assist in clean-up efforts.

If you have already filled this form out at a MARC location or have called 211 to request volunteer assistance for flood cleanup, your information has been entered into the database, and you do NOT need to fill out this form.

The purpose of this form is to compile information for volunteer assistance. This is NOT a mechanism for any type of reimbursement or financial assistance. This is NOT a damage assessment form.
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Homeowner/Resident Name *
First and Last Name
Phone #1 *
(XXX) XXX-XXXX
Phone # 2
(XXX) XXX-XXXX
Email Address
Street Address *
House Number & Street
Unit/Apartment #
City/Town *
Zip Code *
County
For example: Oakland
Are ALL residents 65 or older?
Clear selection
Are any residents designated as disabled?
Clear selection
Please note special needs or physical challenges:
Are you the property owner, or are you a renter?
Certain services cannot be provided without signed consent from the property owner.
Clear selection
If you are a renter, what is the homeowner's name?
First and Last Name
If you are a renter, what is the homeowner's phone number?
(XXX) XXX-XXXX
Is insurance covering part or all of the damage?
Clear selection
If insurance is covering damage, how much?
(Percentage)
Where was the water in home?
How much water was in you Basement?
Number of inches at the flood's highest point.
How much water was in your First Floor?
Number of inches
Are there still flood-affected belongings that need to be removed?
Clear selection
What appliances, if any, were severely damaged or destroyed?
Damaged beyond use.  This is for data collection purposes only.
What damaged appliances still need to be removed?
Is the basement finished?
Is there paneling and/or drywall?
Clear selection
If basement is finished, has flood-affected drywall and/or paneling been removed?
Other than concrete walls and floor, has any surface that was touched by floodwater been removed?
Clear selection
If volunteer groups are available, would you like to request volunteer assistance with flood cleanup at your residence?
Help removing flood-affected belongings, "mucking" out (removing mud, silt, sand, floodwater), gutting flood-affected walls (drywall/paneling), bleach spraying.
Clear selection
Since the flood, has a volunteer organization or contractor already worked on the property?
Clear selection
If yes, what is the name of the organization or contractor?
If yes, what work did they complete?
Additional Notes
Any additional information
MARC Location
(Office Use Only)
Intake Representative
(Office Use Only)
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