COVID-19 FEMA Survey

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* 1. Select pay period timeframe:

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* 2. Member’s name

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* 3. Member’s Email

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* 4. Counties Served

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* 5. How many hours did you serve during this period?

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* 6. What the name and location of the community or organization did you support or partner with (e.g. School, Red Cross, faith-based, community group, etc.)? Please provide full address.

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* 7. Brief description of activities performed during this period. Who and how did you help?