COVID 19 COMMUNITY ASSESSMENT - Family Relief Nursery

COVID 19 COMMUNITY ASSESSMENT FORM

Please choose a location that you are nearest too.

….not on the list. Check your local Relief Nurseries for Community resources.

1. Are you in need of assistance and would you like to talk to our Family Engagement Coordinator?

…frncg.org will have a list of resources.

2. Do you have basic needs being met during this time?

3. Below is a list of basic needs. Select ALL that you are currently struggling with.

Food
Housing | Shelter
Emotional Support
Diapers | Wipes | Baby Formula

Feel free to be more specific about your individual needs in question 4.

4. If this pandemic is affecting you or your family in a negative way, please explain with examples so we can better assist you. If not affected, please leave blank.

Please fill out your name and email so we can contact you. *

First

Last

Email *

If you would like our Family Engagement Coordinator to contact you, please leave your number here.

Name

WE ARE HERE FOR YOU

OPEN

Monday - Friday: 8:00AM - 4:00PM
(Phone until 4:00PM)

LOCATION

720 N 14th St, Cottage Grove, OR 97424
Phone:+ 541 942 4835

"OUR MISSION"

Family Relief Nursery seeks to stop the cycle of child abuse and neglect through prevention and early intervention that strengthens parents, builds successful and resilient children, and preserves families.

We provide services to all unique community members of various cultures, racial/ethnic backgrounds, religious beliefs, financial status, age, sexual orientations, and abilities.