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Collective Impact Survey
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Lealman Exchange Quarterly Impact Report 2023
Thank you for being a valued member of the Lealman Collective Impact. We appreciate your time and support in compiling insight that will allow us to best serve the Lealman Community Residents.
Email Address
(Required)
The email to be included with my response.
Organization Name
(Required)
Contact Name
(Required)
Organization's Mission
(Required)
Please list current programs providing direct support to Lealman Residents *
(Required)
Number of clients served through the Lealman Exchange (as either a walk-in client on-site, a participant in LEX programming, a visitor to an event or function or as a referral from a LEX team member or the Needs Navigator)
(Required)
Please enter a number from
0
to
10000.00
.
Number of clients served from the Lealman community as tracked by zip code
(Required)
Please enter a number from
0
to
10000.00
.
Number of Male Clients Served
(Required)
Please enter a number from
0
to
10000.00
.
Number of Female Clients Served
(Required)
Number of children (under 18) served
(Required)
Please enter a number from
0
to
10000.00
.
Number of Veteran's served
(Required)
Please enter a number from
0
to
10000.00
.
Number of senior's served
(Required)
Please enter a number from
0
to
10000.00
.
Services provided
(Required)
Community Connectivity
Health & Wellness
Educational Advancement
Economic Empowerment
Other
Facility Rental
First & Last Name
Contact Email
Organization Name
Which space at LEX are you interested in renting?
Neri Event Room (3,057 sq. ft.)
Gymnasium (8,639 sq. ft.)
Classroom (600 sq. ft.)
Long Term Lease
Date of Event
MM slash DD slash YYYY
Time of Event
Hours
:
Minutes
AM
PM
AM/PM
What type of event are you planning?
(Required)
How many people do you expect to attend?
(Required)
Open to the public?
YES
NO
Nonprofit Organization
Yes
No
Are you affiliated with Pinellas County?
Yes
No
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