The following questions assess the specifics of your situation, as well as your immediate needs. This will aid us in connecting you to the most appropriate resources. The data collected will be used to more convincingly illustrate the potential loss that would result if the spaces were allowed to fail. These data could not be any more important as we move forward and look for funding and policy support to ensure the long term and permanent life of these types of spaces.
Note on privacy:Your responses are strictly confidential. When information sharing is required in order to connect needs to resources, the data will be assigned a unique case number. We will seek your permission to share your contact information before connecting you to the resource we have located for you.
Direct all questions about this form to firstname.lastname@example.org