First Name *

Last Name

Phone *

Email *

Questions:

1. Which neighborhood or area of East Brooklyn do you live in or represent? *

2. What are the top three issues or concerns in your community right now? *

3. What local programs, resources, or services do you believe are most needed in your area? *

4. How would you like to get involved with InnRes EBV in the future? *

5. Have you ever participated in or heard about any InnRes EBV programs or events? *

Yes — I’ve participated

Yes — I’ve heard about them

No — Not yet