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Purpose

The LEAP Coalition is working to assess the needs and concerns of community residents. Your responses will help us determine the needs within our communities and look for resources to address those needs.

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* 1. What zip code do you live in?

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* 2. If you would like to be informed of services and updates of COVID-19 as they become available, please enter a valid email address or working cell number.

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* 3. Please indicate up to FIVE of the biggest needs that you have right now.

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* 4. Please indicate up to FIVE of your biggest technology needs that you have right now.

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* 5. Please indicate if you would like assistance or more information on the following programs:

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* 6. What other needs or concerns do you have that are not listed above?

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* 7. Are you able to leave the house and come to a central location to pick things up if they were made available for distribution?

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* 8. If you do not have an email address or working cell number, how would you like to stay informed or updated?

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* 9. If you checked any of the options at the last question, please enter your preferred method of contact (mailing address, phone number, or social media name and platform- Facebook, Instagram, etc.).

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