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Community Needs Assessment Form

We appreciate your assistance in identifying needs/issues facing our community. WTLW's goal is to help address those needs through our programming. Your identity will be kept confidential.

Your Name (required)

Your Email (required)

Company (If applicable)

Title

Address

City

State

Zip

Phone

Through your community relationships and experiences, please describe concerns (needs/issues) expressed in these areas:

Economic, Educational, Racial, Cultural, Family, Health, Faith, Social, Arts, Other

May we contact you if we have questions about the information you shared above?
 Yes No

Note: All information will be kept confidential.