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2. On May 18-19, multiple Whitehall households experienced basement flooding. Please use this form to self-report your flooding. Your data may be used in future storm water mitigation studies. Please note that this form is not for requesting assistance.
4. First Name*
5. Last Name*
7. Street Number*
8. Street Name*
9. Street Type*
10. Apt #
12. City*
13. State*
14. Zip*
16. E-mail address*
17. Type of residence*
    -- Select One --Single-familyMulti-family
19. Please upload photos of your damage
23. If you had to estimate, how many inches/feet of flooding occured?*
    -- Select One --Under 6 inches6 inches to a footOne to two feetOver two feet
25. Please describe your flooding incident
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field