COVID-19 Unmet Needs Roundtable Intake

Question Title

* 1. How did you hear about NYDIS' COVID-19 assistance?

NYC.gov website

I received assistance from NYDIS in the past

Friend or Relative

Social Media

Other (please specify)

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* 2. What's your contact information?

First Name *

Last Name *

Address *

Address 2 *

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number

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* 3. How many TOTAL people are in your household?

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* 4. How many people under 18 live in your house?