Hazard Survey - West Central Arkansas Planning and Development District Inc.

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West Central Arkansas Planning and Development District Inc.

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Name

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Have you been affected by a natural disaster in the last ten years? *

Yes
No

If yes, what was the natural hazard event(s)?

How concerned are you about natural hazard events in your area? *

Very concerned
Somewhat concerned
Not concerned

How prepared are you for a natural disaster event? *

Completely prepared
Somewhat prepared
Not prepared
Don't know where to start

Does your insurance provide coverage for natural hazard events? *

Yes
No

If YES, what coverage do you have? i.e. flood, earthquake, etc.

Do you own or rent your place of residence? *

Own
Rent

Do you know of areas in your city/county that are in need of mitigation to lessen/prevent damage from natural disaster events? *

Other comments or concerns:

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WCAPDD does not discriminate on the basis of race, color, national origin, sex, age, or disability in its program and activities (specifically 40 C.F.R. 5.140 and 7.95)

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