AICH-NYC COVID-19 Relief Box Survey
American Indian Community House will be distributing relief boxes for community members and indigenous families affected by the pandemic this Saturday 1-4 pm at 366E 146th street, Bronx NY.

Necessities need to be met, and we are determined to make sure you feel supported. Please fill the survey below to reserve.
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Name: *
Phone number and email: *
Shipping Address: *
What is your nationality? *
Are you Hispanic, Latino, or Spanish? *
If you are indigenous, what nation? *
Has your income been affected during the pandemic? (yours or that of the adults who economically support the household)
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Do you currently have income?
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If no: For how many months have you had no income?
How many people are depending on you financially? (Or how many people in your household depend on the main worker)
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Have you or any of your family members caught covid?
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Please rank from 1 to 10 how much help you need to get this product: General hygiene products (for the bath, soap for hands or for showering)
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Please rank from 1 to 10 how much help you need to get this product: Feminine hygiene products (sanitary pads, menstrual products)
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Cleaning products
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Sanitizing products
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Canned foods (chilies, tuna, corn, refried beans)
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Fresh food (vegetables, fruits)
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Legumes (rice, beans, lentils, tortillas)
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What do you think you need more support with?In order of priority, how would you order the following? 1 being your highest priority and  4 being your last priority *
1
2
3
4
Help with bills (rent, electricity, telephone, internet)
Food products
General hygiene products (for the bath, soap for hands or for showering)
Feminine hygiene products (sanitary pads, menstrual products)
Sanitizing products
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