DNWAYNE - COVID-19 Needs Assessment Survey

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* 1. What is your First and Last Name?

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* 2. What is the best telephone number to call or text you?

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* 3. What is your email?

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* 4. Do you currently receive services from the Disability Network of Wayne County Detroit?

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* 5. What are the critical issues you need help with during the COVID-19 emergency?

Access to Fresh Food

Delivery or Transportation to Medication

Access to the Internet

A telephone or computer to access the Internet

Access to my Personal Doctor for Health Appts or Care

Homelessness

Domestic Abuse or Child Abuse

Educational Resources for my Children

Mental Health Issues - Need a Therapist

Substance/Alcohol Abuse

No Water/Electric/Clean Laundry/Waste Management

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* 6. Have you ever applied for Comcast Essentials for Low-Income Internet

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* 7. Do you have a child who gets free lunch in the home?

Yes

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* 8. What are some critical needs that you have right now as a result of the COVID-19 Emergency?

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* 9. Do you have a caregiver?

Yes

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* 10. Do you need a caregiver?

Yes

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* 11. Do you need technology to assist you in your daily living?

Yes

DNWAYNE - COVID-19 Needs Assessment Survey

Question Title

* 1. What is your First and Last Name?

Question Title

* 2. What is the best telephone number to call or text you?

Question Title

* 3. What is your email?

Question Title

* 4. Do you currently receive services from the Disability Network of Wayne County Detroit?

Question Title

* 5. What are the critical issues you need help with during the COVID-19 emergency?

Question Title

* 6. Have you ever applied for Comcast Essentials for Low-Income Internet

Question Title

* 7. Do you have a child who gets free lunch in the home?

Question Title

* 8. What are some critical needs that you have right now as a result of the COVID-19 Emergency?

Question Title

* 9. Do you have a caregiver?

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* 10. Do you need a caregiver?

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* 11. Do you need technology to assist you in your daily living?

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* 12. How can our organization assist you in your time of need during this emergency?