RAC-G FY19 2018-2019 EMS Needs Assessment v1.1 This survey is to assist in the RAC budget, planning, and regional priorities. This form replaces our Needs Assessment Form of previous years. THE DEADLINE is August 1st, 2018 for submission!Please at the end of the survey provide any unlisted equipment and/or training. Question Title * 1. Your Contact Information Your Name: EMS Provider: Address: City: Zip Code: Email: Office Number: Cell Number: TAX ID / EIN Number: Question Title * 2. Is your license current in every county you service??: Yes No Next