Impact of COVID and CARES Act Funding

Questions marked with a * are required

100%

Contact Information

First Name

Last Name

Email Address

Zipcode

Tribe

Program

Types of programs/services provided
Please select all that apply.

Center-based care

Home-based care

Relative caregiving

Home-visiting

Resource & referral

Other

Please help us tell the Tribal story about how you are being impacted by the coronavirus. They continue to work on solutions, so we have to share now!

Share your story

What are your critical needs? What would help you the most? Please be specific and exhaustive. No need is too small.

Do you self identify as:

American Indian/ Alaska Native/ Native Hawaiian

White

Black (African American, Afro-Caribbean, African including North and Sub Saharan)

Latinx (Hispanic, Caribbean, Mexican, South and Central American)

Other

Check this box if you do NOT want your name to be published.

Please do not publish my name.

NICCA may use my story or comment.

Yes

No

Powered by QuestionPro Share This Survey

Loading...