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.**
Organization Name *
Your answer
Organization Category (select all that apply) *
Required
Organization Address *
Your answer
Organization Phone Number *
Your answer
Organization Email Address *
Your answer
Organization Website Address *
Your answer
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. *
Your answer
Please detail what your organization needs (e.g., donations, volunteers, technology solutions, etc.) to continue doing what it is doing. *
Your answer
Which of the following specific needs of community members is your organization addressing? (Check all that apply.) *
Required
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.)
Your answer
Please provide any other important information you would like the mapping tool to share.
Your answer
Please provide your organization's Twitter handle or Facebook @username if you would like us to share updates.
Your answer
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