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Listos California
Regional Disaster Ready Summits
Pre-Attendance Survey
*
1.
Organization Information
(Required.)
Contact Name
Name of Your Organization
Organization Address
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Contact Email Address
Contact Phone Number
2.
Please select the county(s) that your organization is based in:
Alameda
Alpine
Amador
Butte
Calaveras
Colusa
Contra Costa
Del Norte
El Dorado
Fresno
Glenn
Humboldt
Imperial
Inyo
Kern
Kings
Lake
Lassen
Los Angeles
Madera
Marin
Mariposa
Mendocino
Merced
Modoc
Mono
Monterey
Napa
Nevada
Orange
Placer
Plumas
Riverside
Sacramento
San Benito
San Bernardino
San Diego
San Francisco
San Joaquin
San Luis Obispo
San Mateo
Santa Barbara
Santa Clara
Santa Cruz
Shasta
Sierra
Siskiyou
Solano
Sonoma
Stanislaus
Sutter
Tehama
Trinity
Tulare
Tuolumne
Ventura
Yolo
Yuba
*
3.
Number of people from your organization that are attending: (1-10)
(Required.)
1
2
3
4
5
6
7
8
9
10
4.
Please provide names and emails of other attendees from your organization:
*
5.
Which Regional Disaster Ready Summit will you be attending:
(Required.)
San Diego:
September 28
Palm Springs:
September 29
Los Angeles
: September 27
Ventura:
September 22
Santa Rosa:
September 18
Placerville:
September 13
Chico:
September 15
6.
Do you or anyone from your organization have food allergies/diet restrictions: please list the name and allergy/restriction so we can ensure we accommodate their needs.
7.
Do you need live interpretation in order to participate? If so, please specify language.
8.
Do you or anyone from your organization have other needs we should be aware of to ensure full participation at the Summit? If so, please specify.
9.
We have a minimal number of $25 gas cards to help support organizations that need financial assistance to be able to attend the Regional Disaster Ready Summits. Please check the box below if you would like to request a travel scholarship.
Yes
No
10.
Do you have any questions about the Regional Disaster Ready Summits we can address in upcoming communications?
Pre-Summit Questions:
*
11.
What are the most effective ways to communicate to your community during a disaster?
(Required.)
Door-to-Door Canvassing
Phone Calls
Text Messages
Community Meetings
Radio Advertising
Digital Advertising
Mailings
Social Media
Providing information through local community groups/organizations
House meetings
Neighborhood Flyering
Advertising in local small businesses
Newspaper ads
Other (please describe)
*
12.
What are the top reliable locations community members can seek shelter during a disaster such as a wildfire, earthquake, flooding, or extreme heat/cold?
Please be specific in naming locations.
(Required.)
*
13.
Please list the key partners (state, county, or local) you would go to when a disaster hits to provide resources and support for your community in each of the following categories:
(Required.)
Shelter
Rescue
Public Information/Awareness Services
Food / Clothing
Assistance with accessing government resources
*
14.
What resources is your community lacking to effectively and safely manage a disaster?
(Required.)
*
15.
How can we strengthen partnerships between State and CBOS and/or CBO to CBO?
(Required.)
*
16.
Describe the area/region/communities in which your organization is active.
(Required.)
*
17.
Select which of the following are your organizations core competencies:
(Required.)
Direct grassroots engagement (phone or door-to-door canvassing)
Community organizing (house meetings, community mobilization, etc..)
Grant making
Service provider
Public policy development
Public policy advocacy
*
18.
If your organization is a service provider, please select your area of focus:
(Required.)
Health Care
Workers Rights / Labor Issues
Financial Assistance
Employment / Workforce
Housing
*
19.
Select which of the following issue areas your organization is focused on/has expertise:
(Required.)
Health Care
Climate Change
Labor Issues
Restorative Justice
Civic Engagement
Environmental Justice
Workforce Training
Economic Development
Housing
Youth Development
Education
Other (please specify)
Click the "Done" button below to complete the survey.