Needs Survey Needs Survey This is not an application for assistance. Please contact United Way Suwannee Valley at (386)752-5604 to inquire about assistance. I understandInitials(Required)Date of Birth(Required) MM slash DD slash YYYY Household Size(Required)How many people are currently living with you and are part of your household/family?Children under the age of 18 living with me(Required) Yes No Please identify your top 5 needs at this time.(Required)Please note that these are not all services provided by United Way of Suwannee Valley, we are simply collecting information on what services the community needs.Select exactly 5 choices. Deposits Rental Assistance Mortgage Assistance Utility Assistance (Ex. Power, Water, Gas) Home repair or improvements (Ex. Water leaks, ramps, roof repair) Hotels/Temporary Housing Car Repair Car Payment Assistance Transportation Gas Voucher Food College Payment Assistance Healthcare Prescription Assistance Tax Assistance Legal Services (Ex. Criminal Defense, Divorce) Document Replacement (ID, Social Security Card, Birth Certificate) Clothing Furniture Moving Assistance Job Search/Application Assistance OtherIf a need was not listed above, please fill in what you are looking for below.
