Church Name
Contact Person
Position
Email
Phone
Address
City
State
ZIP
Church Membership Size
Please answer these questions for the time-frame of April 20th (beginning of oil spill) through today.
Has your church experienced a decline in offerings?
Yes or No
Has your church experienced an increase in requests for the following? If yes, by how much (percentage)?
Food
Rental / Mortgage Assistance
Utility Assistance
Counseling / Intervention
Requests for Jobs /Job Training
Other services you have been asked to provide:
Have you experienced an increase in the following issues in your community?
Substance Abuse
Crime
Marital / Physical Conflict
Emotional Problems
Other issues not listed:
What is the greatest issue facing your church at this time?
Identify any of the following service programs provided by your church:




















Other programs and services you offer:
Thank you for your help. This information will be used as a guide to identify needed services and resources with a goal of advocating for churches and developing a coordinated response to the human needs of our community.