*By completing this survey, you are consenting to share your information to gain resources. This is not a guarantee that you will receive services. We are not responsible for your losses, damages, or illness.

The purpose of this document is for the families who are in dire need of basic necessities. Our priority is serving families with children ,elders, and others with healthcare needs while the Navajo Nation is in "Shelter in Place" (staying home to prevent the spread of the COVID-19). We are asking you to complete this survey to identify your basic needs during this time. We appreciate your honesty. Aheheé