Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Disaster Assistance Information Form

  1. Type of Assistance Required*
  2. Evacuation Transportation Necessity*
  3. Emergency Contacts
    List your emergency contacts below.
  4. Release of Information
    I hereby authorize Roscommon County Central dispatch to release all or part of such information as may be necessary to ensure my safety, treatment, and well being in the event of a medical disaster or public emergency.
  5. Leave This Blank:

  6. This field is not part of the form submission.