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The following 31 questions are designed to develop a greater understanding of the needs of your community. When answering these questions, please consider both your personal needs and the needs of the community in general. You may mark multiple answers in many of the questions. If you only identify 1 or 2 of the items as priorities, then only check that many boxes. If the priority you identify is not on the list please write it below the question with any comments you may have. This survey should take about 10 minutes to complete.

Thank you for taking the time to complete this survey!

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* 1. What do you feel are the primary EMPLOYMENT issues in this your community (check a maximum of 3 boxes)

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* 2. What do you feel are the primary EDUCATION issues in your community (check a maximum of 3 boxes)

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* 3. What do you feel are the primary HOUSING issues in your community (check a maximum of 3 boxes)

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* 4. What do you feel are the primary NUTRITION issues in your community (check a maximum of 3 boxes)

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* 5. What do you feel are the primary INCOME issues in this county (check a maximum of 3 boxes)

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* 6. What do you feel are the primary TRANSPORTATION issues in your community? (check a maximum of 3 boxes)

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* 7. What do you feel are the primary HEALTH CARE issues in your community (check a maximum of 3 boxes)

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* 8. What do you feel are the primary YOUTH issues in your community (check a maximum of 3 boxes)

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* 9. Are there unmet needs for childcare services in your community?

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* 10. If you answered YES to QUESTION 9, what do you believe are the primary barriers to obtaining child care services? (check a maximum of 3 boxes)

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* 11. What are the most important unmet CHILDREN'S needs in your community? (check a maximum of 3 boxes)

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* 12. What do you think are the main issues facing FAMILIES in the community? (check a maximum of 3 boxes)

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* 13. What do you think are the main areas that need more attention (check a maximum of 3 boxes)

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* 14. What do you believe are the main factors leading to drug use in the community? (check a maximum of 3 boxes)

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* 15. Were you able to access needed services in your community?

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* 16. If you answered NO to QUESTION 15, please check all of your needs that went unmet in the past year.

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* 17. If you or someone you know were experiencing one of the following problems, would you know where to get help?

  Yes No
Inability to pay gas/electric bills
Inability to pay water bills
Home in foreclosure
Homelessness
Bad credit
Lack of child care
Home in need of repairs
Disability resulting in inability to work
Domestic violence
Unemployment
Parenting stress
No food
Poor nutrition and unhealthy lifestyle
Substance abuse problems
Suicidal thoughts
Stress from providing care to a disabled or ill loved one
Free tax preparation assistance (low and moderate income)
Adult education (GED, etc)
Mental Health difficulties
The following questions ask some personal information. We only ask these questions to make sure we get surveys from different demographic groups within the community. Your name is not on the survey, so all of your personal information will remain confidential.

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* 18. In which county do you live?

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* 19. In which city/town do you live?

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* 20. What is your zip code?

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* 21. Please indicate your age bracket:

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* 22. Please indicate your gender:

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* 23. Please indicate your ethnicity:

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* 24. Please indicate race:

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* 25. Please indicate household type:

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* 26. How many people live in your household?

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* 27. Please indicate your TOTAL household income:

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* 28. Please indicate your TOTAL household income – 3 YEARS AGO:

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* 29. Please indicate your source(s) of household income: (please check all that apply)

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* 30. Please indicate your highest level of education

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* 31. Please indicate your email address if you would like to be invited to the Community Forum in your county. Your email information will not be connected to your survey answers

Thank you for taking the time to complete this survey. We will be holding a community forum to discuss the survey results about community needs, and would love your participation, as we work to better understand the needs of the counties and to to most effectively address solutions.
 
100% of survey complete.

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