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* 1. Do you live in Lassen County?

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* 2. How many children do you have?

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* 3. What are your children's ages?

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* 4. Are you experiencing any hardships due to the COVID-19 Pandemic? Please describe.

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* 5. Is there anything that you need that you are unable to get/find/buy during this time? Please describe.

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* 6. Are there any necessary services that you are unable to access in some way during this time? Please describe.

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* 7. Personal Information (Optional)

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