Survey - Disaster Relief Application

*	Question - Required - Local Association Name
	Question - Not Required - ED/CEO Name
	Question - Not Required - Point of Contact (if person other than ED/CEO)
*	Question - Required - Phone Number
*	Question - Required - Contact Email
*	Question - Required - Is the association in good standing?
*	Question - Required - Area served by the local association was received a federal disaster declaration
*	Question - Required - List specific programs affected
*	Question - Required - Describe how your local association has been affected by the natural disaster? (physical damage to property, interruption in services, etc)
*	Question - Required - Number of people affected
	Question - Not Required - What is the estimated cost of the recovery needs?
*	Question - Required - What are the immediate needs to return to providing essential services to the community?
*	Question - Required - Do you have insurance that will cover any of the recovery costs?
*	Question - Required - Describe any long term programmatic needs that you have identified as a result of the natural disaster.