COVID-19: Bangladesh Community Needs Assessment

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* 1. Personal information

Name

Address

City/Town

Email Address

Phone Number

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* 2. Financial hardship - Current work status

part-time

unemployed

student

tourist

Other (please specify)

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* 3. Do you have severe financial hardship due to COVID-19? Please explain why?

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* 4. The minimum financial support you require to survive during COVID-19 lockdowns (visit https://covid19.govt.nz/resources/information-sheets/#easy-read-factsheets to understand stages)

Stage 4 lock down

Stage lock down

Stage 3 lock down

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* 5. Communication and delivery supports

Are you in mandatory self-isolation?

Are you suffering severe health conditions?

Are you unable to shopping outside?

Are you unable to cook at home?

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* 6. If you are not working COVID-19 period. How best you could utilize this time, please describe? (e.g. gardening, training, learning new ideas, etc.)

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* 7. For your professional development what additional training you want? Please ignore if not relevant.

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* 8. What additional support do you expect during the COVID-19 period?