General 

In order to best serve the community after the winter storm of 2021, please answer the questions below. 

Once your information has been received, a team of volunteers will review your input and ensure your application is sent to the most appropriate service organization. 

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* 1. General Intake

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* 3. Race/Ethnicity

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* 4. Household

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* 5. In order to make the most appropriate referral, please indicate your currently annual household income: 

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