Needs Assessment for Senior Citizens during the COVID-19 Pandemic

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* 1. Do you live in Lassen County?

Yes

No

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* 2. How many people are in your household?

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* 3. What is your age? (Optional)

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* 4. Are you experiencing any hardships due to the COVID-19 Pandemic? Please describe.

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* 5. Is there anything that you need that you are unable to get/find/buy during this time? Please describe.

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* 6. Are there any necessary services/resources that you are unable to access in some way during this time? Please describe.

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* 7. Personal Information (Optional)

Name

Phone Number

Email Address