Youth Membership Needs Assessment
ROC & PEC Youth Centre is here to support you.

We want to understand from you what resources are available to you at home. This will help us ensure you are receiving the support you need.  

The information you provide is confidential and will not be shared.

We hope you are staying safe & healthy. If you need to talk to ROC staff,  we'd be happy to hear from you.

Lindsay: lindsay@theroc.ca | 613-408-6204                                                              
Claudia: claudia@theroc.ca | 613-408-7624

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First Name *
Last Name *
Please provide the best way to contact you (ie Facebook, Email, Phone #)
Do you and your family need help getting food?  (ie. Frozen Meals, Grocery Cards, Healthy Snacks)
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Do you and your family need personal hygiene products? (ie. soap, deodorant,  shampoo, conditioner, tampons/pads, tooth paste, tooth brush ). Tell us what you need.
Do you need a Laptop, Chromebook or iPad for school work?
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Do you need art supplies? (ie. sketchbook, markers). For Community Art Project Members
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Do you need a fabric/reusable mask?
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Best phone number to reach you at *
Do you want to pick up or have delivered? *
For delivery, please include your address
Submit
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