Liberty Strong
2019 Community Needs Survey
First and Last Name *
Your answer
Best phone number and time to call *
Your answer
Would you like to add a co-applicant or an alternative contact? If yes please enter their First and Last name, phone number, and relationship to you below
Your answer
Please describe your CURRENT housing situation
Please list the address for your CURRENT residence
Your answer
Please list how many adults and children are in your household
Your answer
Are you living in unsafe condtions?
In your own words, please describe your current situation.
Your answer
Is there anything else you would like for us to know?
Your answer
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