Thank you participating in our survey. With your feedback, we will be able to better prepare our resources to support and enhance the important work you do each day in the community. We anticipate this survey will take about 15 minutes to complete.

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* 1. Organization name

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* 2. Your name

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* 3. What is the primary geographic scope of your organization? (Select all that apply)

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* 4. Is your organization led by a person of color (i.e. president/CEO/ED)?

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* 5. Is your client population more than 50% people of color?

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* 6. What is your primary focus as an organization? 

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* 7. Please estimate the percent in each age demographic for the core population you serve (% Estimates for each )

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* 8. Please estimate the percent of your core clients meeting the description below (if applicable) (% Estimates for each- may exceed 100%)

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* 9. Approximately how many clients does your organization typically serve monthly (pre-COVID-19)?

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* 10. Has the number of clients served changed since the COVID-19 pandemic?

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* 11. If YES, clients served increased, by what additional percent?

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* 12. If YES, clients served decreased, by what percent? (approximately) 

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* 13. What is your core/primary service? (select one)

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* 14. What is/are your secondary service(s)? (Select all that apply)

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* 15. What core services and programs do you typically provide that you are now not able to offer? (If you are providing all of your normal core services and programs, enter N/A)

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* 16. What new services, if any, are you providing due to COVID-19? Please describe the changes.

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* 17. Have you considered or established any new collaborations/partnerships as a result of the pandemic?

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* 18. Do you have serious concerns about your organization’s viability in the next 12 months?

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* 19. Over the past two months, how have your staffing levels been impacted by COVID-19? (check all that apply)

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* 20. What methods have you used to sustain your business operations? (check all that apply)

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* 21. From which of the following sources, if any, have you received financial assistance? (check all that apply)

Short-Term Gaps (Next 1-6 Months)

Please provide information on the short-term impact on your target population that you anticipate or forecast over the next 1-6 months as a result of COVID-19.

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* 22. What primary needs/challenges do you anticipate your core population will have in the next 1-6 months? (Select all that apply)

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* 23. What are key factors that could exacerbate the needs identified or alleviate them?

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* 24. Please provide information on short term gaps in services or resources that you anticipate or forecast for your organization over the next 1-6 months. Describe the gaps:

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* 25. Provide a cost estimate of the gaps over the next 1-6 months

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* 26. What, if any, plans are your organization already considering to help address the short-term gaps?

Near-Term Gaps (Next 6mo – 1yr)

Please provide information on the near-term impact on your core population that you anticipate or forecast over the next 6 months to 1 year as a result of COVID-19.

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* 27. What primary needs/challenges do you anticipate your core population will have? (Select all that apply)

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* 28. What are key factors that could exacerbate the needs identified or alleviate them?

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* 29. Please provide information on near term gaps in services or resources that you anticipate or forecast for your organization over the next 6 months to 1 year. Describe the gaps 

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* 30. Provide a cost estimate of the gaps over the next 6 months – 1 year

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* 31. What, if any, plans are your organization already considering to help address the short-term gaps?

Long-Term Gaps (over 1 year +)

Please provide information on the long-term impact on your target population that you anticipate or forecast in the next 1 year + as a result of COVID-19.

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* 32. What primary needs/challenges do you anticipate your core population will have in a year and over?

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* 33. What systemic issues do you foresee occurring in this time frame (1 yr+) ?

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* 34. On which issues would systems-level or advocacy support be most helpful to you in the next year? 

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* 35. From a capacity building perspective, what resources, training or information does your organization need? 

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* 36. What actions would be most helpful for the community to take to support your organization right now? 

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* 37. What other information would you like to share with us as it relates to your organization and the COVID-19 pandemic?

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