SE Como Request for Support
This form will be used to match support requests to volunteers offering support. The results from this form will remain confidential and may be used to inform programs and services during SECIA's response to COVID-19.
What is your name and preferred pronouns?
Your answer
Please provide your phone number (Is texting okay?)
Your answer
Please provide your e-mail address
Your answer
Are you interested in staying up to date on programs and services offered by SECIA and around the neighborhood, by receiving our bi-weekly newsletter?
What kind of support are you looking for? (Check all that apply)
If you're seeking financial relief, please provide more detail so we can direct you to the best resource
Your answer
Any additional resources or requests we didn't think of
Your answer
Who are we reaching?
The following questions will help us understand who we are reaching, they are completely optional will not be used to determine the matching of support to those who need it.
Are you affiliated with the U of M?
What best describes your age?
Do you identify as Spanish, Hispanic, or Latinx?
How would you describe yourself? (Check all that apply)
Where did you find this survey?
Submit
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This form was created inside of SECIA - Southeast Como Improvement Association. Report Abuse