Connective Survey Data Request Form

Connective is a Greater Houston area disaster and preparedness nonprofit dedicated to serving our community through technology and human-centered design.

Prior to submitting your request for data, please review the impact assessments available on the Connective website. If you are unable to locate the information you are looking for, please complete this form. The time to receive data depends on the complexity of the request and availability of our staff. Please give us as much advanced notice as possible if you are working with a deadline.

*Please note: Survey respondents information will only be shared if they have agreed to share their information with other nonprofit organizations involved in disaster recovery efforts.

Requester's Information

First name:

Last name:

Primary Phone Number:

Email Address:

Organization:

Other Organization:

Job Title:

Survey Request

Data Request

If other, please indicate from which program you are requesting data?

Do you have resources (money or services) to assist the survey respondents?

YesNo

Please briefly describe what resources or services you have for the survey respondents:

Tropical Storm Imelda Data Request

The data you need may be available on the Tropical Storm Imelda Data page. Do you still need to proceed with your data request?

YesNo

2023 Tornado Data Request

The data you need may be available on the 2023 Tornado Dashboard. Do you still need to proceed with your data request?

YesNo

COVID-19 Data Request

The data you need may be available on the Gulf Coast COVID-19 Survey Data page. Do you still need to proceed with your data request?

YesNo

2021 Winter Storm Data Request

The data you need may be available on the Connective 2021 Winter Storm Survey Results page. Do you still need to proceed with your data request?

YesNo

Data Detail

In order to protect the privacy of the respondents, the individual level data will be grouped by their geography.

Please choose a geographic range for your data:

Zip CodeNeighborhoodOther

If other, what geographic range do you need?

Data Detail

In order to protect the privacy of the respondents, individual level data will only be shared if it is needed to provide assistance.

Will you need to contact the survey respondents to provide them assistance?

YesNo

Will you need the street address to provide assistance? (for example: Muck and Gut services or Storm Debris Removal)

YesNo

Please choose a geographic range for your data:

Zip CodeNeighborhoodOther

If other, what geographic range do you need?

Purpose

Please briefly describe the purpose of this data request (How will it be used? Who is the intended audience? Is it supporting a specific project or program?)

Time Request

Data requests will take between 5-7 business days to complete.

Date data is requested by:

Time Request

Data requests will take between 2-3 business days to complete.

Note: Requests for Contact Information or Street Level will require a Data Sharing agreement to be completed between Connective and your organization. This may add up to 2 weeks to the processing time.

Date data is requested by:

Additional Information

Once this request is submitted and reviewed, you will receive an email regarding your request.

If you have any questions or need assistance filling out this form, please contact us at info@connectivetx.org.

Survey Ending

Thanks for your interest!

Contact Information