Request edit access
Community Support & Needs Assessment
This survey is designed to both:
1. Assess survivors needs & 2. Garner community support

As families, some with children, we are all impacted by COVID-19 Quarantine. Reduced financial income, lack of basic needs and/or illness due to the virus is REAL. Shyne San Diego & The Survivor Business Network continue to be a proven social impact model for grassroots community organizing at its best!!!

We ARE connecting our network of human trafficking and gender violence survivors with:
1. Community Sharing
2. Professional Opportunities for Income
3. Emotional Support
4. Online Trainings for our Members

If you'd like to VOLUNTEER to help please let us know in the form below.

We encourage everyone to practice self quarantine and EXTREME social distancing, wash hands & face, call support people, practice daily Gratitude journals and help your community as much as possible.

You can come back anytime to submit a new form as your circumstances change.

AS A COMMUNITY WE WILL OVERCOME ALL ADVERSITIES.
_____________________________________________________________
Please Use These Hashtags when sharing. Thank you.

#SurvivorBusinessNetwork #commUNITYimpact #StayHome #SurvivorAdvisors
Email address *
Name and Phone Number *
Your answer
Todays Date *
MM
/
DD
/
YYYY
Q1. I am a survivor of human trafficking, gender violence or commercial sexual exploitation. (if No Skip to Question 5)
Q2. I need help with (check all that apply)
Moderate Alert
Major Concern
High Alert
Emergency Status
Toiletries
Food
Medical Supplies
Transportation
Cell Phone Payment
Internet Access
Emotional Distress
Mental Distress
Rent Payment
Other
Q2.5 I'd like to learn or attend virtual classes (check all that apply)
Don't Need
Need
Really Need
Need NOW!
Meditation
Yoga
Healthy Eating Recipes/Support
Exercise
YouTube
Marketing/PR
Increase customers/clients
Filing Taxes
Q3. My family size includes: list ages of all in the home
Your answer
Q4. I live in (City, State)
Your answer
Q5. I am able to help PROVIDE support
Q6. I am able to HELP assist with needed community organizing efforts
Q7. I can SHARE with my network requests for items/support
Q8. Add any additional comments or concerns to help us develop the most effective assessment
Your answer
SHYNE San Diego & THE SURVIVOR BUSINESS NETWORK
CREATING A COMMUNITY OF GOOD
CONTACT US OR FIND OUT MORE...
www.shynesd.org
www.victorygardensanctuary.org

COVID19 EMERGENCY FUND: www.PayPal.Me/theshenway

Emergencies ONLY please text: 619-940-7756

To help us BEST address the growing needs of our community please allow Up to 72-hrs for response

STAY INSIDE & STAY HEALTHY!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy