YIS COVID-19 Needs Assessment 

The purpose of this form is to collect information about you and how you have been affected by the pandemic. All responses are confidential. 

To be eligible for assistance, you should be 18 to 24 years old, low to moderate income, identify as LGBTQ+ and have been impacted disproportionately by the COVID-19 pandemic. 

Race/Ethnicity: Select the following that apply to you
Gender Identity/Sexual Orientation: Select the following that apply to you

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MS Address:

460 Briarwood Drive

Suite 400-40

Jackson, MS 39206

FL Address:

11901 4th Street N

Unit 9104

St. Petersburg, FL 33716

EIN/Tax ID Number: 83-2799349​

DUNS Number: 080398644​

CAGE Code: 8B3H3

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