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2021 Winter Storm Needs Assessment

Please fill out this 10 min. survey to share your needs with local non-profits. Your participation will allow us to advocate for more resources for our community and strengthen recovery efforts. This isn’t an application for assistance, but you can opt-in to receive text messages about new resources as they become available.

The personal information you enter on this survey will not be shared with government agencies.
Respondent Information

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Impact of the 2021 Winter Storm on the Household
Living Situation

Home Damage

We're very sorry to hear that. Make sure to take as many pictures of the damage as possible. Taking pictures will be useful in proving losses to FEMA, your insurance company, and for other relief agencies should assistance become available. 

We will have resources for you on how to apply for assistance after you submit the survey. 

Other Household Impacts
The 2021 Winter Storm affected people in different ways. Other than any home damages, are there other ways in which your household has been impacted by the Winter Storm? Please select all that apply below:

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Household Demographics

Please estimate the total income for the entire household for the month of January 2021 (before taxes and deductions).

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Primary Household Member Information
Please note: We will never share your name, address, or any personally identifiable information with any government entity. 

Consent & Release

Our Partners