HUMAN Basic Needs Survey for Greater Milford

HUMAN Basic Needs Survey for Greater Milford

In order to help us best prepare and align community resources, it is our hope that you will complete this brief survey. Your responses will help us prioritize our community response efforts as well as ensure specific information reaches individuals who are in need.

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* 1. As you think about your current needs at this time can you rank your priorities in scale "1" being highest priority and "7" is the lowest priority?

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* 2. What are you prioritizing that we have not listed above?

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* 3. Are you interested in or in need of information on Residential Property, ADA Modification or Code Corrections and Repairs?

Yes

No

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* 4. If you would like more information on Residential Property, ADA Modification or Code Corrections and Repairs, please include the best contact e-mail below:

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* 5. Would you like us to contact you for any specific follow-up?

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number