This form collects information about the immediate needs of families of children and youth with special needs (CYSHCN) during emergencies. The information will be used to assist in coordinating necessary resources and support.  Upon completion, a family is eligible for one $25 gift card.  Additional information and assistance may follow.  NOTE: Support pertains to residents of Alleghany, Ashe, Avery, Mitchell, Watauga, Wilkes, and Yancey county residents of North Carolina.