Member Agency Monthly Survey Report
Thank you to everyone working so hard to help the many people across Long Island during this pandemic. The need in the community is continuing to grow and your support is needed more than ever. We can not express enough how much we appreciate your partnerships!
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Name of Member Agency:
Member Agency Information *
Reporting Period:
Member Agency ID: This is a 6 digit number. For example: 012-345
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Survey Prepared By:
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Cell Phone Number:
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E-mail Address:
County *
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