Community Organizing - Hopi Household Survey
Thank you for participating in our event. We hope you can fill out the survey and share with others to get additional resources organized for the community.

We want to hear your feedback so we can act quickly and get needed resources to our community and members. Please fill this quick survey and let us know your thoughts (your answers will be anonymous).
I am in need of the following; *
Required
I am willing to VOLUNTEER - Must be Healthy, not sick or ill. *
Required
What do you see as basic needs in the community that are not covered above?
Your answer
My observation of my immediate family needs. *
1 = Not High, I can do this on my own. 5 = Very High, we need support.
1
2
3
4
5
N/A
Basic household needs: Grocery, home goods.
Continued Employment & Finances
Child Care
Access to Water
Utilities & Services
Physical Activity
Tending to Ceremony or Cultural Needs
In Home Care
Wood for Heating Home
Animal Supplies
Emotional Support
Healthcare Access/Needs
Row 13
Home Education - COVID 19
Additional feedback or consideration for organizers. *
Your answer
I have strong family support.
Both presented and pre-read material
I live alone or take care of myself/family, not much support from the outiside
I have strong family support or have regular support daily.
Name (optional)
Your answer
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