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* 1. Have you experienced a need for assistance in the last 18 months (April 2020 – September 2021)?

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* 2. Please indicate areas of assistance your household would use to help recover from impacts of the pandemic (check all that apply):

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* 3. Are you currently experiencing a need for Health Service Support?

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* 4. Please indicate areas of Health Service Support that will help maintain or improve your health and well-being(check all that apply):

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* 5. Do you have children or adults in your household that are currently enrolled in school?

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* 6. Please indicate areas of assistance that will help support success in school or other education/training programs (please check all that apply):

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* 7. Do you manage or own a local business/nonprofit?

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* 8. Please indicate areas of assistance that will help your business/nonprofit recover from the negative economic impacts of the pandemic (please check all that apply):

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* 9. Please provide any additional information or feedback that may help us develop projects/programs that will assist you.

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