Greater Pine Island Civic Association Post-Ian Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

It's been nearly nine months since Hurricane Ian caused catastrophic damage to our community. The Greater Pine Island Civic Association is conducting this survey to assess how post-Ian recovery is going for members of our communities — Matlacha Isles, Matlacha, St. James City, Pine Island Center, Pineland and Bokeelia. Please tell us how you're doing, whether you have unmet needs and what your most pressing concerns are. We will share this information with long-term recovery groups working on the Island so that we may demonstrate our community's needs in order to seek additional support and resources. Thank you for taking the time share your information. Please note: We will not share your email address with any other group or agency unless you give us explicit permission to do so in the second question of this survey and that we are only collecting names of those Islanders who are seeking help from long-term recovery groups.

Email *

Do we have your permission to share your name, address, email address and information about any unmet needs you have with groups focused on long-term recovery? *

Yes

Where is your Pine Island residence? *

Matlacha Isles

Matlacha

Pine Island Center

St. James City

Pineland

Bokeelia

Is this your primary residence? *

Yes

Do you own or rent? *

Own

Rent

Are you a full-time or part-time resident? *

Full Time

Part Time

Required

How many people live in your household?

If any of them are younger than 18, please tell us how many and list their ages.

How was your household affected by Hurricane Ian? Please choose all that apply. *

Not Impacted

Displaced for up to 4 weeks

Displaced for more than 4 weeks

Still displaced

Minor damage to residence

Moderate damage to residence

Major/catastrophic damage to residence

Loss of job or income source

Household finances disrupted

Minor injuries sustained by member of household

Major injury sustained by member of household

Loss of life in my family or friend group

Other

Required

If you are still displaced by the storm, what is your current living situation?

I'm living in my home amid unrepaired damage

I'm living in an RV on my property

I'm living in a tent on my property

I'm staying with family or friends

I've secured alternate housing that I am paying for while I rebuild

Other

If your home was damaged by the hurricane, what are your plans (or what have you done)? *

Repairing/rehabilitating/rebuilding my residence

Relocating from Pine Island

Selling my property

Required

Do you currently have plans to permanently relocate away from Greater Pine Island? *

Yes

Maybe

What do you think are the Island's most pressing needs today?

Do you still have unmet needs? *

Yes

If yes, please tell us what your needs are.

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms