Do you need flyers
or additional information?

Support Form (#1)

Name of Organization

First Name

Last Name

Email

Phone/Mobile

Address Line 1

Address Line 2

City

State

Zip Code

Would you like flyers delivered to you?

Yes

No

If so, how many?

Do you need flyers in Spanish?

Yes

No

If so, how many?

Would you like to schedule a speaker/presentation to talk about the program?

Yes

No

Virtual or in-person?

Virtual

In-person

Will the speaker have capabilities of sharing a powerpoint?

Yes

No

Is this request for an already planned event?

Yes

No

If so, when is the event?

How long will the presenter have to speak?

Target audience:

Target area or neighborhood:

Would you like to host a mobile Help Desk?

Yes

No

Can you commit to gathering at least 15 people that need assistance in completing the Emergency Rental & Utility Assistance application?

Yes

No

Are you able to distribute a checklist to the applicants beforehand to ensure that they bring all necessary documents with them?

Yes

No

Will the location be able to provide wifi?

Yes

No

Will the location be able to provide tables and chairs and appropriate space to practice social distancing?

Yes

No

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