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* 1. What is your contact information (*Required)

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* 2. How was your community impacted? (Check all that apply)

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* 3. What long-term recovery needs or concerns do you anticipate?

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* 4. What is the approximate percentage of damage to the following categories?

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* 5. Based on funding limitations, how would you prioritize your recovery needs?

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* 6. Of the residents impacted, what percentage are low-to-moderate income households?

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* 7. Has your community received any of the following sources of recovery funding? (Check all that apply)

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* 8. How often is the community impacted by this type of disaster?

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* 9. What types of mitigation projects could help?

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* 10. How long do you expect recovery to take?

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