IRCO CNA

IRCO Community Needs Assessment

IRCO Community Needs Assessment Conference

Saturday, July 8th, 2017 8 a.m.- 4 p.m.

Pre-Registration Form

This conference will (1) identify and prioritize needs of each of the newly-arrived as well as the more established immigrant and refugee communities; (2) set goals to address those needs through cohesive programming, community advocacy and policy change that promote equity, self-sufficiency and integration; (3) provide policy updates and other resources to community members.

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* 1. Personal Information

First Name

Last Name

Address

City

State

Zip Code

Phone Number

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* 2. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65+

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* 3. What is your gender?

Female

Male

Transgender

Non-Binary

Prefer Not to Say

Other (please specify)

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* 4. What community will you be representing at the conference?

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* 5. Prioritize Your Community's Needs: what are the TOP three concerns for your community?

Community Development

Discrimination

Domestic and Family Violence

Early Childhood

Economic Development

Education

Elder

Employment

Health

Housing

Immigration

Refugee Resettlement

Transportation

Trauma Care

Youth Engagement and Support

Other (please specify)

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* 6. What language(s) do you speak?

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* 7. Will you need an interpreter?

Yes

Visit www.irco.org/CNA for more information or contact Sokho Eath at sokhoe@irco.org or 971.271.6536