Regional Community Health Needs Assessment
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1. Demographic Information
12%
1
. What is your age/gender?
What is your age/gender?
0-18 Male
0-18 Female
19-29 Male
19-29 Female
30-44 Male
30-44 Female
45-54 Male
45-54 Female
55-64 Male
55-64 Female
65+ Male
65+ Female
2
. What County do you live in?
Allamakee
Bremer
Butler
Cerro Gordo
Chickasaw
Emmet
Fayette
Floyd
Franklin
Hancock
Howard
Humboldt
Kossuth
Mitchell
Winnebago
Winneshiek
Worth
Wright
NOT LISTED
What County do you live in?
3
. What is your Ethnicity?
What is your Ethnicity?
Native American
Pacific Islander
Asian
Hispanic
African-American
Caucasian
Other (please specify)
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