Tribal Community Member Post-Disaster Needs Assessment Survey

Purpose of this Survey

The National Indian Justice Center (NIJC) is grateful that the wildfires have been controlled and our communities' safety has been restored. We are asking Native Americans (individuals and families) that have been impacted by the Northern California Wildfires to tell us about their fire recovery-related needs. NIJC is serving as a Long-term Recovery Center for our fire-effected region. Beginning in February 2018, the Center will provide Native individuals and families with case management coordination and referrals to services. We will also be conducting workshops and events to promote recovery. The Center is located at NIJC at 5250 Aero Drive, Santa Rosa, CA 95403.

Please visit our website at http://nijc.org to learn more about the Center and see the workshop and events schedule.

We appreciate you taking time to complete this survey. The information you provide is confidential and will assist us in connecting you to aid. For questions, contact Ben Myers at benmyers@nijc.org

This survey can be accessed online at: https://www.surveymonkey.com/r/YLWF2D2

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* 1. Please provide your contact information:

Name of Person:

What Tribe are you from (if any):

Address

City/Town

State

ZIP Code

Email Address

Phone Number

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* 2. Have you been impacted by the Northern California Wildfires?

Yes

Please briefly describe how you were impacted: (i.e., temporarily evacuated, lost home, lost belongings, lost job)

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* 3. Which county did you live in at the time of the fires?

Mendocino County

Lake County

Sonoma County

Napa County

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* 4. Were you living on tribal lands at the time of the fires?

Yes

Which Tribal Community were you living in?

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* 5. What was/is your address at the time that your county was impacted by the wildfires?

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* 6. How many people live in your household?

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* 7. How many people in your household are under the age of 18?

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* 8. Which agencies or organizations have you received assistance from, if applicable? Please choose all that apply.

FEMA

American Red Cross

Salvation Army

California Office of Emergency Services (CalOES)

Bureau of Indian Affairs (BIA)

Indian Health Services (IHS)

None of the Above

Other (please specify)

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* 9. Have you filed an application for Individual Assistance with the State of California?

Yes

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* 10. Have you lost items of cultural significance due to the fires?

Yes

Please briefly describe the items lost:

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* 11. What type of assistance are you in need of?

Replacement of household items

New housing

Assistance with Insurance claims

Advice for tax preparation

Job training

Job placement

Counseling for Trauma associated with the fires

Networking with cultural practitioners to help with replacement of cultural items

Other (please specify)

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* 12. Do you or your family members require specific accommodation for health, mental health, mobility issues, or other access and functional needs?

Yes

Please identify the specific accommodation(s)

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* 13. Are you currently employed?

Yes

Yes, I am self-employed

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* 14. Did the fires negatively impact your job/career? E.g. did you lose tools, resources, to work from home if you are self-employed?

Yes

Please describe how your job/career was negatively impacted.

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* 15. Would you like NIJC to contact you about fire-related case management coordination and referral services?

Yes

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* 16. What is your preferred method of contact?

Phone

Other (please specify)