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Defensible Space Assistance Form
This form has been modified since it was saved. Please review all fields before submitting.
This is my primary residence:
If "No" please provide address:
I am the owner of this property:
If "No" please provide owner's name:
This form must be approved by the owner before work can be performed.
Total acres of property:
Number of structures protected:
I understand that:
This is a one-time assistance program to create defensible space and wildfire education. The program is not for removal of trash or trees over 8" in diameter. Completing this application does not guarantee that you will be assisted; applicants will be prioritized with the following criteria:
1. Financial Ability
Number of people in household:
Related children under 18 years:
This section is based on your Defensible Space Evaluation. Please use the link below for more information and contact Ian Appow at (541) 556-4985 or email@example.com to set up a free consultation if you have not already received an evaluation.
Defensible Space Evaluation
Priority is based on the address's radius to potential wildfire impact which considers vulnerability, emergency road access, utilities and topography. This also accounts for legal limitations, living in the eligibility zone, and proximity to other priority project sites.
4. Fire Marshal's Assessment of Impact
I certify by signing below, this is true and correct: I understand that defensible space created by the WUI Collaborative and their contractors does not guarantee that my home will not be lost in the event of a wildfire. I understand that ongoing maintenance is a critical component of wildfire resiliency past the one-time service this project provides. This service is provided on numerically generated data that determines the order of priority. I agree to provide access to water, bathroom facilities, and use of any onsite tools to complete the necessary work in cooperation with the NYC crews. I certify that the above information regarding income is true and correct and I understand that the information provided is subject to verification in qualifying to receive service.
By checking this box, I am providing an electronic signature.
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