Covid-19 Crisis Form
The Collective Church would like to know how you and your family have been or is currently being impacted by Covid-19.
Email address *
Full Name *
Phone Number *
Are you a member of The Collective Church *
Are you in a Collective Community Group *
Have you been laid off due to Covid-19? *
Have your hours been reduced due to Covid-19? *
Have you or a family member been diagnosed with Covid-19? *
How many family members live in your household (include ages of children)? *
What are your current needs or issues you are dealing with? *
Required
*If you are in need of financial assistance, please give all necessary details below.
Additional Comments or Concerns you want us to know about regarding the impact of Covid-19?
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