Rural Family Needs Survey
We know during this COVID-19 pandemic that access to supplies and items to keep our rural communities safe has been more difficult than usual. We are grateful to all the governmental and tribal service organizations that are working hard to provide medical and food supplies for communities in need.

We at Changing Woman Initiative have created a COVID-19 Emergency Response Team to work on getting essential items for families that may have not been included during this crisis. If you live in northern New Mexico and are in need of these essential items, please complete this survey. We have ideas on what may be needed for inclusion in care packages, but we need your feedback. We cannot guarantee availability of your requests, but we will try our best. We understand there may be limitations to package delivery and receiving mail in some very rural areas. We will what we can to coordinate with local/tribal officials and support our families as much as possible during this time.
Email *
Name *
Where are you located? *
What is your email? *
Do you have adequate internet/WiFi access? *
Are there any postal limitations in your area we should be aware of (i.e. delayed package delivery, limited post office hours, lack of rural addressing)? Is there something helpful we should be aware of to get supplies to your area (i.e. checkpoints, tribal lockdown policies)? *
Please select your top 5 items you would like to receive in a care package, or make suggestions in the "other" below. *
Required
Changing Woman Initiative has access to herbal medicines. Would you need any for your family? *
Are you filling this questionnaire out for an elder or family member in need? Could you please provide your relationship to the person you are filling this out for?
Please provide any additional comments, suggestions, or questions here: *
Changing Woman Initiative | 505-930-5641 | www.changingwomaninitiative.com
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