Thank you for taking the time to fill out our survey!

Dear community members, we are reaching out to you during the COVID-19 pandemic to gain an idea of the most urgent community needs. Please respond to the questions below. Any personal information shared will be confidential.

If you would like someone from NROCRC to follow-up with you, please call 613-596-5626 or email magordon@nrocrc.org.

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* 1. Please indicate your postal code in the list below; this will help us identify where in our catchment that specific need exist.

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* 2. Please share your age. This will help us determine the right service for you.

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* 3. What are your current main concerns related to COVID-19? Check all that apply.

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* 4. How many family friends or relatives do you have who can support you in times of need? (eg. Pick up groceries or medicine for you, accompany you to a doctor's appointment if you are unwell, look after children, etc)

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* 5. Do you have access to a telephone at home?

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* 6. Do you have access to a computer with internet access (wifi) at home?

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* 7. Do you have access to a device with internet connectivity?

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* 8. Do you receive financial support from the government as your family's main source of income (eg. Welfare, Ontario Works, ODSP, OSAP, CCB etc)?

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* 9. Has your household's employment status been affected by COVID19? Check all that apply.

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* 10. Are you eligible to recieved Canada's Emergency Response Benefit (CERB)?

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* 11. Thinking about the next 3 - 6 months, what are your concerns?

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* 12. If you would like us to follow up with you or a wellness call, please share your phone number or email address.

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