CAANE Comprehensive Community Needs Assessment Question Title * 1. Employment is a problem in this area because: People lack skills to obtain a job Unable to find jobs in the area Lack of good paying jobs with benefits Cost of child care Cost of transportation Employers leaving the area/country Lack of transportation Question Title * 2. Education is a problem in this area because: No high school diploma Lack of GED Cost of child care Lack of computer skills Cost of transportation Lack of tuition money Lack of vocational skills Lack of family support Question Title * 3. Housing is a problem in this area because: Cost of rent/house payment Cost of utility/rent deposit Lack of temporary emergency housing Affordable housing not available Need weatherization Need repairs (roof, foundation, plumbing, etc.) Lack of shelters for emergency situations (domestic violence) Lack of homeless shelters Question Title * 4. Nutrition is a problem in this area because: Not enough income to purchase food Food stamps run out before end of month Not eligible for food stamps Lack of education in nutrition Alternative food resources not available (pantries, food banks) Lack of food Question Title * 5. Use of income is a problem in this area because: Difficulty with money management/budgeting Available income spent on addictions and/or luxuries rather than necessities Lack of use of earned income tax credits Question Title * 6. Transportation is a problem in this area because: Cost of buying/down payment for a car Lack of credit to buy a car Cost of maintaining a car Cost of gasoline Question Title * 7. Health care is a problem in this area because: Lack of insurance Lack of income to pay for prescriptions Existing health conditions Lack of resources for alcohol or drug abuse treatment Lack of resources for mental health treatment Question Title * 8. Please enter the following demographic information: Name: * Company: * Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: Email Address: Phone Number: Question Title * 9. What is your gender? Female Male Question Title * 10. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race? White Black or African-American American Indian or Alaskan Native Asian Native Hawaiian or other Pacific Islander From multiple races Question Title * 11. Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group? I am not Spanish, Hispanic, or Latino Mexican Mexican-American Chicano Puerto Rican Cuban Cuban-American Some other Spanish, Hispanic, or Latino group From multiple Spanish, Hispanic, or Latino groups Done