Community Needs Assessment

302 Hospital Drive, Corsicana, TX 75110
(903) 872-2401
[email protected]

Community Services, Inc. Ten-County COVID-19 Community Needs Assessment

This will help me, your community partner, Daniel Edwards, Sr. stay up to date with your needs in the community as the COVID-19 crisis continues to evolve.

Name *

Phone *

Please use the following format: 123-456-7890

Email *

Street Address *

Street Address

City

State/Province

Zip/Postal

Which of these challenges are directly impacting your family?

I'm worried about being able to afford food and basic necessities.

Myself or someone in my household is considered at high-risk due to their age or underlying health conditions

I'm an essential worker that is still reporting to work and I'm worried about my exposure.

I'm worried about ensuring that my children receive the education they deserve.

I need to see a doctor, but I'm not because I have little or no health insurance.

I'm feeling sick but continue to go to work because I have no paid sick leave.

I lost my job or lost hours at work due to the pandemic

Other challenges that are directly impacting your family?

What questions do you have for us?

Which organizations have you used for assistance? How was your experience? Please, share their information or website here.

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If you are human, leave this field blank.

Community Services, Inc. Ten-County COVID-19 Community Needs Assessment

John

Sandy

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Community Services, Inc. Ten-County COVID-19 Community Needs Assessment