Exit Winter Storm Support Survey Question Title * 1. Name and Phone Number Question Title * 2. Enter complete address information Question Title * 3. Please Describe Your Family Details ( Please List the Age, Sex (male/Female),Clothing Size, Shoe Size, and Allergies) Question Title * 4. Race White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Other (please specify) Question Title * 5. Income Under $15,000 Between $15,000 and $29,999 Between $30,000 and $49,999 Between $50,000 and $74,999 Other (please specify) Question Title * 6. Needs Food Home Clean Up Home Goods Clothing Other (please specify) Question Title * 7. Please tell us your immediate needs. Can send video to 832-347-9458 Done