United Way Manitowoc County's COVID-19 Basic Needs Relief Fund Survey
As we come together as a community to help each other through this difficult time, an essential part of slowing the spread of COVID-19 and reducing the impact on our local hospital systems is voluntary social distancing and self-isolation.

United Way is surveying community stakeholders and partners to help us better understand what support is available to our community to assist with these practices. It is our intention to simultaneously identify gaps that could potentially be unfilled by national, state and other local funding. Your response will help guide United Way’s process to put relief dollars where they are needed most.

Please use the following list to indicate all potential support that your organization has the capacity to provide. Additionally, please be sure to answer the final question letting us know where you may need assistance and/or what you are hearing from your team members (staff and volunteers).

For questions, please contact United Way Manitowoc County.
Phone: 920-682-888 Email: info@unitedwaymanitowoccounty.org
Your Organization's Name *
Your answer
Primary Contact First and Last Name *
Your answer
Preferred Phone Number *
Your answer
Preferred Email Address *
Your answer
Mailing Address *
Your answer
My organization provides the following support(s). Please mark all that apply.
What time of day are you providing support?
Are there any other supports that you offer or could potentially offer that aren’t on the list above?
Your answer
What are some potential needs that you hear are making it difficult for others/yourself to isolate at home? Please mark all that apply.
What are some current needs of your organization - volunteer, supplies, funds, etc.? Please list or describe what your needs are. If funds are a need, please briefly describe how funds would be used and if you are receiving other funds. We'd appreciate your honesty in sharing what other funds you have or will receive in response to COVID-19.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy