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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
Lack of good paying jobs with benefits
Lack of affordable child care during working hours
Resume Writing/Application/Interviewing Skills
Inadequate options for transportation to work

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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
Adults need more opportunities to obtain GED and/or further their education
Need more options for daycare and preschool
Need more programs for elementary and middle school students

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

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* 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.)
Knowledge of how to address credit issues
Difficulty with budgeting, banking, saving money, etc.
Need emergency financial assistance during temporary financial crisis
Insufficient income and other resources to meet basic needs

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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.

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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.
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.
Emergency Assistance - Program that assists with past due rent or utility payments when they have an unexpected crisis.
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 Counseling/Foreclosure Prevention - Provides service to counsel clients with mortgage foreclosures or prepare for homeownership.
Emergency Home Repair - Targeted towards low-income seniors and disabled residents, provides modest home repairs that could include plumbing and new wells.
Energy Efficiency Education - Helps low-income clients learn how to reduce utility costs through education and in-home counseling.

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* 6. How would you describe yourself?

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

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* 8. Please indicate your age range.

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* 9. Please indicate your annual household income.

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* 10. Please indicate your household type.

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