2016 Louisiana Flooding Followup Survey Please take a moment to complete our followup survey for the 2016 Louisiana Flood. If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required First Name * Last Name * Temporary Address * Temporary Address (Line 2) Temporary City * Temporary State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Temporary Zipcode * Email * Phone * Are you FEMA eligible? * YesNo Have you requested a FEMA trailer? * YesNo If denied a FEMA trailer, what was the stated reason (250 character response) Are you living in a situation that is stable for six months or longer? * YesNo What is your current living arrangement? * New Rental LeaseStaying with FamilyLiving in home while repairing itStaying with Friends Do you need mattresses? * YesNo If yes, how many twin mattresses do you need (two twins can be placed next to each other as a king size bed)? Do you need pillows and linens for bedding? * YesNo Does your child like Legos? * YesNo If your child likes Legos, please list up to 3 Lego sets we could help replace for your child. Did you receive a weighted blanket from UA? * YesNo Would you like a weighted blanket if we are able to secure another shipment? * YesNo Did you lose your car during the flood? * YesNo Have you been able to secure new transportation? * yesNo Please check all items which would help your family get settled the most quickly: iPadSensory toysPECS systemKitchen utensils, pots, pans, plates, cupsBathroom linens & shower curtainsSofa or beanbag chairsTable and chairsStorage/organizational containersGift cards for winter clothes Tell us anything else you may need.