Brown County COVID-19 Community Resource and Response Mapping Tool Information Collection Form
This form is designed to collect basic information about how your organization is responding to the COVID-19 crisis.

Your responses to the following questions will populate an interactive map on Achieve Brown County's website, the overarching purpose of which is two-fold:

1. To demonstrate how organizations from all sectors across the county are responding to the crisis and addressing the needs of community members.

2. To help us collectively address what needs are not being addressed, and then explore how we can all coordinate and collaborate to address them.

**Please fill out this form for each location if you would like to include information for multiple locations throughout the community.**
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Organization Name *
Organization Category (select all that apply) *
Organization Address *
Organization Phone Number *
Organization Email Address *
Organization Website Address *
Please describe what your organization is currently doing (e.g., resources it is providing, services it is delivering, etc.) in response to the COVID-19 crisis. *
Please detail what your organization needs (e.g., donations, volunteers, technology solutions, etc.) to continue doing what it is doing. *
Which of the following specific needs of community members is your organization addressing? (Check all that apply.) *
If your organization is providing direct service/support to community members, please provide an estimate of the total number of people being served/supported. (Optional - any number you provide will only be shared in aggregate.)
Please provide any other important information you would like the mapping tool to share.
Please provide your organization's Twitter handle or Facebook @username if you would like us to share updates.
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