Cost of Living Support Assessment 

We understand that the rising cost of living has impacted many lives, making it challenging to meet basic needs. The purpose of this questionnaire is to gain a better understanding of your specific circumstances and needs, so we can provide the most effective support possible.

Your responses will help us identify the types of assistance you may need, whether it's food aid, financial help, medical support, or energy-saving guidance. The more details you provide, the better equipped we'll be to direct our resources in a way that makes a meaningful impact in your life.

Rest assured, all information you provide will be kept confidential and will only be used to improve the services and support we offer.

Thank you for taking the time to fill out this questionnaire. Your input is invaluable to us as we strive to serve you and the community better.

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1. Name *
2. Phone number *
3. Email
4. Location *
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