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* 1. Due to the evolving COVID-19 situation and the economic implications, will you likely need food assistance?

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* 2. How many individuals in your household will need food assistance?

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* 3. How would you prefer to receive food deliveries? 

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* 4. Do you need or anticipate needing any additional assistance? Check all that apply.

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* 5. What municipality do you live in?

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* 6. Are you willing to volunteer your time and efforts to help collect, distribute and/or deliver food or other supplies?

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* 7. What is your name and contact information? This information will only be shared with local organizations and entities coordinating food assistance efforts.

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