Community Needs Survey
This information will help us to work together to address services that are needed the most. All information received is considered confidential and only the Action Survey Committee will have access to the information collected.

Upon receipt of your completed survey we will enter your name for a chance to win one of three $50.00 grocery gift certificates. Please enter your name and phone number in order that we may notify you, should you win the raffle, or to contact you should you request information regarding our programs.

Name and phone number are optional, you only have to fill that information out if you wish to be entered for a chance to win one of the three grocery gift certificates.
Phone number
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