Combined Community Action is interested in learning more about the needs of the community during the COVID-19 pandemic. Please help us by completing this short survey.

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* 1. Do you need assistance with rent/mortgage?

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* 2. Do you need assistance with food?

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* 3. Do you need assistance with childcare?

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* 4. Do you need assistance with prescriptions?

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* 5. Do you need assistance with transportation to/from work?

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* 6. Do you need assistance with household items? (diapers, toilet paper, etc)

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* 7. Do you need assistance with utilities?

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* 8. Do you need any other type of assistance not listed here?

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* 9. Where did you learn about this survey?

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* 10. Would you like us to contact you? Please leave your name and an email address or phone number

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