A Survey to Prepare Our Community for Coronavirus (COVID-19)

March 2020

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* 1. Name

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* 2. Email

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* 3. Agency

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* 4. Core Service Areas

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* 5. Do you anticipate increased levels of demand for services related to the coronavirus?

Yes

No

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* 6. If yes, to the extent that you know at this point, for what services?

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* 7. Do you have a plan to meet increased need? What obstacles are you anticipating? What help might you need?

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* 8. United Way's 2-1-1 line anticipates receiving increased call volume from individuals, especially those needing assistance with basic needs services. Is it OK for 2-1-1 and others to refer people to your agency during this time?

Yes

No

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* 9. Anything else you're concerned about?

Thank you very much for completing this survey!