Connective Needs Assessment - Registry

Impacted by the recent weather event?

Please fill out this two-step survey to help assess the level of impact after a disaster and share your needs with local non-profits and/or local government. 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 available new resources and assistance as they become available.
Primary Household Member Information

We strongly encourage you to provide your email address or that of a trusted friend or family member. 

Please type your street address and city, and then click on the matching result. Please do not include apartment numbers or unit numbers.

Living Situation

Loss of Power

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 insurance companies and other relief agencies should assistance become available. 

Household Members

Consent & Release

4. Are you interested in receiving text notifications about local, free resources and services in our area?
Connective Texts is a free service that sends subscribers 2–3 texts with local resources per week. 

  • You will receive up to 10 text messages/month from Connective related to nonprofit and government resources.
  • You confirm that you are the subscriber to the relevant phone number or that you are the customary user of that number on a family or business plan and that you are authorized to Opt In.
  • Message & data rates may apply.
  • You can opt-out at any time by replying “STOP” to the text messages you receive.
  • You can adjust my subscription settings by replying "HELP" to the text messages you receive.
  • You will be texted a reminder of instructions for opting out of text messages at least once a month.
  • Your phone number will not be shared with any other organization without your explicit consent.

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