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Seniors in Need
Survey of seniors who would like help during COVID-19
1.
Are you a senior or do you know a senior, who would benefit from help during the COVID-19 social isolation period?
Yes
No
2.
What activities do you need help with?
Grocery and supply buying and drop off
Calling to check in on needs
Other (please specify)
3.
Please provide your contact information
Name
Address
Email Address
Phone Number
