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* 1. What is your age group?

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* 2. How many people currently live in your household?

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* 3. How many people in your household are under the age of 18?

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* 4. How do you receive news and information?

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* 5. How have you or a member of your household been impacted by the most recent events?

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* 6. Do you work in any of the following industries?

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* 7. In your current situation, what type of assistance would be most beneficial to you and your household?

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* 8. If you are eligible for any stimulus proceeds from the government, how would you apply it?

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* 9. We are in this together, what else do we need to know?

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* 10. To better assist you, please provide your contact information.

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