Access and Functional Needs Registration Forms

The Durham County Emergency Management Division provides for the voluntary registration of county residents who have access and functional needs and will need assistance during an evacuation.

Access and functional needs include, but are not limited to, lack of transportation; limited English language proficiency; chronic or temporary health conditions; mobility, sensory, physical, intellectual, or cognitive limitations; electrically dependent medical equipment; etc.  

If an evacuation is ordered, shelter for persons with these types of needs will be available. Those with access and functional needs should make prior arrangements for transportation to the shelters; however, transportation will be provided for those unable to make such arrangements or who are unable to provide their own transportation.


To register, please complete the online Access and Functional Needs Registration form below.


Or, you may print and complete the form and email to:

If using regular mail please send your form to:

Durham County Emergency Management
Access and Functional Needs Registry
2422 Broad Street
Durham, NC 27704

  Access & Functional Needs Form 2018 (English)

Access & Functional Needs Form 2018 LARGE FONT (English)