CNA 2012

1. Default Section

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* 1. If you believe EMPLOYMENT is a concern in the community in which you live (whether or not it is a concern for you), please identify the specific areas of concern based on a scale of 1 to 4 with 1 indicating there is no problem and 4 indicating it is a significant concern.

	1	2	3	4
Few jobs for people without skills	Few jobs for people without skills 1	Few jobs for people without skills 2	Few jobs for people without skills 3	Few jobs for people without skills 4
Lack of good paying jobs with benefits	Lack of good paying jobs with benefits 1	Lack of good paying jobs with benefits 2	Lack of good paying jobs with benefits 3	Lack of good paying jobs with benefits 4
Lack of affordable child care during working hours	Lack of affordable child care during working hours 1	Lack of affordable child care during working hours 2	Lack of affordable child care during working hours 3	Lack of affordable child care during working hours 4
Resume Writing/Application/Interviewing Skills	Resume Writing/Application/Interviewing Skills 1	Resume Writing/Application/Interviewing Skills 2	Resume Writing/Application/Interviewing Skills 3	Resume Writing/Application/Interviewing Skills 4
Inadequate options for transportation to work	Inadequate options for transportation to work 1	Inadequate options for transportation to work 2	Inadequate options for transportation to work 3	Inadequate options for transportation to work 4

Comments or suggestions related to this area of concern.

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* 2. If you believe EDUCATION is an area of concern in the community in which you live, please indicate below which specific areas are of concern using a rating scale of 1 to 4 with 1 indicating not a problem and 4 indicating a serious concern.

	1	2	3	4
Need supportive/college prep programs for youth	Need supportive/college prep programs for youth 1	Need supportive/college prep programs for youth 2	Need supportive/college prep programs for youth 3	Need supportive/college prep programs for youth 4
Adults need more opportunities to obtain GED and/or further their education	Adults need more opportunities to obtain GED and/or further their education 1	Adults need more opportunities to obtain GED and/or further their education 2	Adults need more opportunities to obtain GED and/or further their education 3	Adults need more opportunities to obtain GED and/or further their education 4
Need more options for daycare and preschool	Need more options for daycare and preschool 1	Need more options for daycare and preschool 2	Need more options for daycare and preschool 3	Need more options for daycare and preschool 4
Need more programs for elementary and middle school students	Need more programs for elementary and middle school students 1	Need more programs for elementary and middle school students 2	Need more programs for elementary and middle school students 3	Need more programs for elementary and middle school students 4

Comments or suggestions related to this area of concern.

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* 3. If you believe HOUSING in an area of concern in the community in which you live (whether or not it is an area of concern for you), please indicate below the specific areas of concern. Rate items on a scale of 1 to 4 with 1 indicating no problem and 4 indicating a serious problem.

	1	2	3	4
Lack of quality, affordable housing to rent	Lack of quality, affordable housing to rent 1	Lack of quality, affordable housing to rent 2	Lack of quality, affordable housing to rent 3	Lack of quality, affordable housing to rent 4
Local home prices are too high/unaffordable to purchase	Local home prices are too high/unaffordable to purchase 1	Local home prices are too high/unaffordable to purchase 2	Local home prices are too high/unaffordable to purchase 3	Local home prices are too high/unaffordable to purchase 4
Utilities are too expensive	Utilities are too expensive 1	Utilities are too expensive 2	Utilities are too expensive 3	Utilities are too expensive 4
Housing needs repairs or weatherization	Housing needs repairs or weatherization 1	Housing needs repairs or weatherization 2	Housing needs repairs or weatherization 3	Housing needs repairs or weatherization 4
Lack of temporary emergency housing	Lack of temporary emergency housing 1	Lack of temporary emergency housing 2	Lack of temporary emergency housing 3	Lack of temporary emergency housing 4
Lack of down payment on a house	Lack of down payment on a house 1	Lack of down payment on a house 2	Lack of down payment on a house 3	Lack of down payment on a house 4
Knowledge of how to buy a home	Knowledge of how to buy a home 1	Knowledge of how to buy a home 2	Knowledge of how to buy a home 3	Knowledge of how to buy a home 4
Foreclosure Prevention Counseling	Foreclosure Prevention Counseling 1	Foreclosure Prevention Counseling 2	Foreclosure Prevention Counseling 3	Foreclosure Prevention Counseling 4

Comments or suggestions related to this area of concern.

Question Title

* 4. If you believe MONEY MANAGEMENT is an area of concern in the local community (whether or not it is a concern for you), please indicate the specific areas of need below using a scale of 1 to 4 in which 1 indicates there is no problem and 4 indicates a signficant problem.

	1	2	3	4
Lack of knowledge of possible resources (food stamps, Medicaid, etc.)	Lack of knowledge of possible resources (food stamps, Medicaid, etc.) 1	Lack of knowledge of possible resources (food stamps, Medicaid, etc.) 2	Lack of knowledge of possible resources (food stamps, Medicaid, etc.) 3	Lack of knowledge of possible resources (food stamps, Medicaid, etc.) 4
Knowledge of how to address credit issues	Knowledge of how to address credit issues 1	Knowledge of how to address credit issues 2	Knowledge of how to address credit issues 3	Knowledge of how to address credit issues 4
Difficulty with budgeting, banking, saving money, etc.	Difficulty with budgeting, banking, saving money, etc. 1	Difficulty with budgeting, banking, saving money, etc. 2	Difficulty with budgeting, banking, saving money, etc. 3	Difficulty with budgeting, banking, saving money, etc. 4
Need emergency financial assistance during temporary financial crisis	Need emergency financial assistance during temporary financial crisis 1	Need emergency financial assistance during temporary financial crisis 2	Need emergency financial assistance during temporary financial crisis 3	Need emergency financial assistance during temporary financial crisis 4
Insufficient income and other resources to meet basic needs	Insufficient income and other resources to meet basic needs 1	Insufficient income and other resources to meet basic needs 2	Insufficient income and other resources to meet basic needs 3	Insufficient income and other resources to meet basic needs 4

Comments or suggestions related to this area of concern.

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* 5. Skyline CAP, Inc. offers the following programs and services to local residents. Please rate how important these programs are to the local community using a scale of 1 to 4 with 1 indicating the program is unnecessary and 4 meaning the program is vital to the community.

	1	2	3	4
Head Start - A preschool program for 3 and 4 year olds from income-eligible families that focuses on preparing children for kindergarten and providing services to their families to improve their ability to be self-reliant.	Head Start - A preschool program for 3 and 4 year olds from income-eligible families that focuses on preparing children for kindergarten and providing services to their families to improve their ability to be self-reliant. 1	Head Start - A preschool program for 3 and 4 year olds from income-eligible families that focuses on preparing children for kindergarten and providing services to their families to improve their ability to be self-reliant. 2	Head Start - A preschool program for 3 and 4 year olds from income-eligible families that focuses on preparing children for kindergarten and providing services to their families to improve their ability to be self-reliant. 3	Head Start - A preschool program for 3 and 4 year olds from income-eligible families that focuses on preparing children for kindergarten and providing services to their families to improve their ability to be self-reliant. 4
Project Discovery - Encouraging high school students to continue education after high school with workshops about financial aid, study skills, self esteem and trips to college campuses.	Project Discovery - Encouraging high school students to continue education after high school with workshops about financial aid, study skills, self esteem and trips to college campuses. 1	Project Discovery - Encouraging high school students to continue education after high school with workshops about financial aid, study skills, self esteem and trips to college campuses. 2	Project Discovery - Encouraging high school students to continue education after high school with workshops about financial aid, study skills, self esteem and trips to college campuses. 3	Project Discovery - Encouraging high school students to continue education after high school with workshops about financial aid, study skills, self esteem and trips to college campuses. 4
Emergency Assistance - Program that assists with past due rent or utility payments when they have an unexpected crisis.	Emergency Assistance - Program that assists with past due rent or utility payments when they have an unexpected crisis. 1	Emergency Assistance - Program that assists with past due rent or utility payments when they have an unexpected crisis. 2	Emergency Assistance - Program that assists with past due rent or utility payments when they have an unexpected crisis. 3	Emergency Assistance - Program that assists with past due rent or utility payments when they have an unexpected crisis. 4
Housing Choice Voucher (Rental Assistance) - HUD housing programs to assist low income individuals or families who can't otherwise afford to pay all of their monthly rent.	Housing Choice Voucher (Rental Assistance) - HUD housing programs to assist low income individuals or families who can't otherwise afford to pay all of their monthly rent. 1	Housing Choice Voucher (Rental Assistance) - HUD housing programs to assist low income individuals or families who can't otherwise afford to pay all of their monthly rent. 2	Housing Choice Voucher (Rental Assistance) - HUD housing programs to assist low income individuals or families who can't otherwise afford to pay all of their monthly rent. 3	Housing Choice Voucher (Rental Assistance) - HUD housing programs to assist low income individuals or families who can't otherwise afford to pay all of their monthly rent. 4
Housing Counseling/Foreclosure Prevention - Provides service to counsel clients with mortgage foreclosures or prepare for homeownership.	Housing Counseling/Foreclosure Prevention - Provides service to counsel clients with mortgage foreclosures or prepare for homeownership. 1	Housing Counseling/Foreclosure Prevention - Provides service to counsel clients with mortgage foreclosures or prepare for homeownership. 2	Housing Counseling/Foreclosure Prevention - Provides service to counsel clients with mortgage foreclosures or prepare for homeownership. 3	Housing Counseling/Foreclosure Prevention - Provides service to counsel clients with mortgage foreclosures or prepare for homeownership. 4
Emergency Home Repair - Targeted towards low-income seniors and disabled residents, provides modest home repairs that could include plumbing and new wells.	Emergency Home Repair - Targeted towards low-income seniors and disabled residents, provides modest home repairs that could include plumbing and new wells. 1	Emergency Home Repair - Targeted towards low-income seniors and disabled residents, provides modest home repairs that could include plumbing and new wells. 2	Emergency Home Repair - Targeted towards low-income seniors and disabled residents, provides modest home repairs that could include plumbing and new wells. 3	Emergency Home Repair - Targeted towards low-income seniors and disabled residents, provides modest home repairs that could include plumbing and new wells. 4
Energy Efficiency Education - Helps low-income clients learn how to reduce utility costs through education and in-home counseling.	Energy Efficiency Education - Helps low-income clients learn how to reduce utility costs through education and in-home counseling. 1	Energy Efficiency Education - Helps low-income clients learn how to reduce utility costs through education and in-home counseling. 2	Energy Efficiency Education - Helps low-income clients learn how to reduce utility costs through education and in-home counseling. 3	Energy Efficiency Education - Helps low-income clients learn how to reduce utility costs through education and in-home counseling. 4

Comments or suggestions related to the programs provided by Skyline CAP.

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* 6. How would you describe yourself?

Community Member

Skyline CAP Client

Social Services Provider

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* 7. In which county do you live or work:

Madison

Greene

Orange

Rappahannock

If you have any other comments or suggestions, please include them below.

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* 8. Please indicate your age range.

17 or under

18-29

30-54

55-65

65+

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* 9. Please indicate your annual household income.

Below $20,000

$20,000 to $29,000

$30,000 to $49,000

$50,000 to $74,000

$75,000 to $99,000

$100,000+

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* 10. Please indicate your household type.

One Person

Single Parent

Two Adults

Two parents and children

Grandparent(s) with grandchildren

Household with adult children