PPCA COVID-19 Support Survey

1. Statement of Need

The Portland Peace Corps Association has established a special fund to support community members with crucial needs due to their evacuation and/or impacts from the coronavirus pandemic. This survey seeks CONFIDENTIAL information that will be used for award determinations.

Question Title

* 1. First please tell us who you are and how to reach you.

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. In which country and in which years did you serve in the Peace Corps?

Question Title

* 3. Were you affected by the 2020 worldwide evacuation of Peace Corps Volunteers?

Question Title

* 4. Today I seek help with...

Food

Housing

Transportation

Other

Please provide a 1-2 sentence statement of need.

PPCA COVID-19 Support Survey

1. Statement of Need

Question Title

* 1. First please tell us who you are and how to reach you.

Question Title

* 2. In which country and in which years did you serve in the Peace Corps?

Question Title

* 3. Were you affected by the 2020 worldwide evacuation of Peace Corps Volunteers?

Question Title

* 4. Today I seek help with...

Question Title

* 5. I seek the following level of assistance.

Question Title

* 6. Though support is not guaranteed, payment will be most prompt if you provide your Venmo ID in this box.