Power Safety Shutoff Resources Application

If you are in immediate danger please contact your local emergency services or dial 9-1-1.

The Disability Disaster Advisory Committee will make the ultimate determination on who qualifies for backup batteries and other resources through an application process. Medical needs and income will be considered as part of the application process.

[Downloadable PDF version]

Seleccione el menú desplegable de idioma en la parte inferior derecha de la página para traducir el formulario.

Contact Info



Use "noemail@disabilitydisasteraccess.org" if you do not have your own email address.


Your Address











Resource Questionnaire



Select a Living Arrangement

If the power were to go out at your home, do you have any backup source of electricity to use?


Are you on the Medical Baseline Program?(Links to external application page)

Do you have a personal or household emergency plan?

Are you willing to work on and use it?

Are you receiving or are you eligible for any type of public benefits?



(Please only click once, the revolving icon means the form is processing.)

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