Request Forms – The Santa Clara County FireSafe Council

Chipping Program Application

ONLY enter house number, street address, and ZIP Code. The system already knows your city/state based on your zip code and WILL NOT show events if entered incorrectly.

Home Ignition Assessment for Property Owners Request

We are currently only accepting HIZ requests for Saratoga and Los Altos Hills due to grant funding.

HIZs are entirely funded by grants and we currently have no funds left in our grants except for with the City of Saratoga and the City of Los Altos Hills. We are hoping to secure more funding in Q1 of 2023.

"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone to Reach You*

Email*

Special Instructions (ex: "Don't use GPS", or, "Park on left side of driveway")

How did you hear about the Santa Clara County FireSafe Council?*

Thank you for your interest!

CAPTCHA

This field is for validation purposes and should be left unchanged.

"Why Go Firewise?" Presentation Request

Name of Neighborhood or Group
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Best Phone to Reach You*
How many households will be attending?*
Please enter a number greater than or equal to 8.
(minimum 8 households)
Host Contact Information, if Different From Above:
Host Name
First Last
Host Home or Venue Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Host's Email
Host's Best Phone Number
Will a projector and screen be available?*
Special Instructions (ex: "Don't use GPS", or, "Park on left side of driveway")
How did you hear about the Santa Clara County FireSafe Council?*
Thank you for your interest!
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Defensible Space Presentation Request

Name of Neighborhood or Group
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Best Phone to Reach You*
How many people will be attending?*
Please enter a number greater than or equal to 12.
(minimum 12 people)
Will a projector and screen be available?*
Special Instructions (ex: "Don't use GPS", or, "Park on left side of driveway")
How did you hear about the Santa Clara County FireSafe Council?*
Thank you for your interest!
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Firewise Committee Presentation Request

Name of Neighborhood or Group
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Best Phone to Reach You*
How many people will be attending?*
(recommended 4-6 people)
Host Contact Information, if Different From Above:
Host Name
First Last
Host Home or Venue Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Host's Email
Host's Best Phone Number
Will a projector and screen be available?*
Special Instructions (ex: "Don't use GPS", or, "Park on left side of driveway")
How did you hear about the Santa Clara County FireSafe Council?*
Thank you for your interest!
Comments
This field is for validation purposes and should be left unchanged.

Wildfire Evacuation Workshop Request

Name of Neighborhood or Group
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Best Phone to Reach You*
How many people will be attending?*
Please enter a number greater than or equal to 12.
(minimum 12 people)
Host Contact Information, if Different From Above:
Host Name
First Last
Host Home or Venue Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Host's Email
Host's Best Phone Number
Will a projector and screen be available?*
Special Instructions (ex: "Don't use GPS", or, "Park on left side of driveway")
How did you hear about the Santa Clara County FireSafe Council?*
Thank you for your interest!
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Guest Speaker Request

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Best Phone to Reach You*
Name of event/meeting/group*
Date
MM slash DD slash YYYY
Location/Venue Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Event Hours
Set up arrival time
Specific topic requests: what topic(s) would you like addressed?*
Does your venue have projector and screen?*
Additional information
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

SCCFSC Booth Request

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Best Phone to Reach You*
Name of Event*
Date(s)*
MM slash DD slash YYYY
Location/Venue Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Event Hours*
Set Up Arrival Time*
Event Day Contact Name*
Event Day Contact Phone Number*
Vendor unloading and parking info and location
Please indicate what your event provides:*
- Table
- Chairs
- Canopy
- Tablecloth
- Vendor/Guest brings own equipment and supplies
Other:
Additional Information
How did you hear about the Santa Clara County FireSafe Council?*
Thank you for your interest!
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.