COVID-19 Needs Assement

We are aware of so many needs as many have lost income, have health issues or are unable to leave home. Please fill out the following form to alert us to the needs you may have to see if we can help match needs to availability.

The name you go by

Why are you applying for this program?

Are you or anyone in your household at an especially high risk of contracting coronavirus due to having severe illness from:

Other Food Delivery Services

Have you ever used any of the following delivery services?

Delivery Address

Delivery Address

What days are you able to accept delivery between 8am and 5pm

Other Information

Have you participated in any of the following programs, groups, or services at The Center?

Youth and Family Services

Senior Services

Health and Wellness

Identi-T Trans and Gender Diversity Programs

Other Programs and Services