Request edit access
Hurricane Harvey TWU Community Impact Assessment
Provides the university with information on who in the university community has been impacted by Hurricane Harvey
Email address *
First name
Your answer
Last Name
Your answer
Affiliation
TWU Campus
Select One
Home Address
Your answer
City
Your answer
Home or Mobile Phone Number
Your answer
Do you have impacts from Hurricane Harvey?
What impacts are you having? (Check all that apply)
Describe how the disaster is currently impacting you.
Your answer
Are these or will these impacts affect your ability to attend class or work at the campus?
Do you need any assistance?
If you need assistance, what are your needs? (Ex: Need sheltering, need clothes, need transportation-please explain, or need information-please explain what type of information)
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Texas Woman's University. Report Abuse - Terms of Service