CNA 2010
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1. Default Section

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.

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Lack of employment office to assist with job hunting.	*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. Lack of employment office to assist with job hunting. 1	Lack of employment office to assist with job hunting. 2	Lack of employment office to assist with job hunting. 3	Lack of employment office to assist with job hunting. 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 child care during working hours.	Lack of child care during working hours. 1	Lack of child care during working hours. 2	Lack of child care during working hours. 3	Lack of child care during working hours. 4
Need assistance with resume writing/interviewing skills.	Need assistance with resume writing/interviewing skills. 1	Need assistance with resume writing/interviewing skills. 2	Need assistance with resume writing/interviewing skills. 3	Need assistance with resume writing/interviewing skills. 4
Lack of options for transportation to work.	Lack of options for transportation to work. 1	Lack of options for transportation to work. 2	Lack of options for transportation to work. 3	Lack of options for transportation to work. 4

Comments or suggestions related to this area of concern.

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
High rate of school drop-out.	*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. High rate of school drop-out. 1	High rate of school drop-out. 2	High rate of school drop-out. 3	High rate of school drop-out. 4
Students need computer access at home.	Students need computer access at home. 1	Students need computer access at home. 2	Students need computer access at home. 3	Students need computer access at home. 4
Insufficient after school programs for youth.	Insufficient after school programs for youth. 1	Insufficient after school programs for youth. 2	Insufficient after school programs for youth. 3	Insufficient after school programs for youth. 4
Lack of opportunities to pursue vocational skills or college.	Lack of opportunities to pursue vocational skills or college. 1	Lack of opportunities to pursue vocational skills or college. 2	Lack of opportunities to pursue vocational skills or college. 3	Lack of opportunities to pursue vocational skills or college. 4
Lack of GED/Adult Basic Education opportunities.	Lack of GED/Adult Basic Education opportunities. 1	Lack of GED/Adult Basic Education opportunities. 2	Lack of GED/Adult Basic Education opportunities. 3	Lack of GED/Adult Basic Education opportunities. 4
Knowledge of financial aid (how to apply, what options are available).	Knowledge of financial aid (how to apply, what options are available). 1	Knowledge of financial aid (how to apply, what options are available). 2	Knowledge of financial aid (how to apply, what options are available). 3	Knowledge of financial aid (how to apply, what options are available). 4

Comments or suggestions related to this area of concern.

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
Rent payments are unaffordable.	*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. Rent payments are unaffordable. 1	Rent payments are unaffordable. 2	Rent payments are unaffordable. 3	Rent payments are unaffordable. 4
Mortgage payments are unaffordable.	Mortgage payments are unaffordable. 1	Mortgage payments are unaffordable. 2	Mortgage payments are unaffordable. 3	Mortgage payments are unaffordable. 4
Utility bills are too high.	Utility bills are too high. 1	Utility bills are too high. 2	Utility bills are too high. 3	Utility bills are too high. 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
Housing size does not meet family needs.	Housing size does not meet family needs. 1	Housing size does not meet family needs. 2	Housing size does not meet family needs. 3	Housing size does not meet family needs. 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 funds for a down payment on a house.	Lack of funds for a down payment on a house. 1	Lack of funds for a down payment on a house. 2	Lack of funds for a down payment on a house. 3	Lack of funds for a down payment on a house. 4
Lack sufficient knowledge about how to buy a home.	Lack sufficient knowledge about how to buy a home. 1	Lack sufficient knowledge about how to buy a home. 2	Lack sufficient knowledge about how to buy a home. 3	Lack sufficient knowledge about how to buy a home. 4
Need counseling/assistance to prevent foreclosure.	Need counseling/assistance to prevent foreclosure. 1	Need counseling/assistance to prevent foreclosure. 2	Need counseling/assistance to prevent foreclosure. 3	Need counseling/assistance to prevent foreclosure. 4

Comments or suggestions related to this area of concern.

4. If you believe NUTRITION 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
Don't use available resources, i.e. food pantries, meal programs, etc.	*If you believe NUTRITION 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. Don't use available resources, i.e. food pantries, meal programs, etc. 1	Don't use available resources, i.e. food pantries, meal programs, etc. 2	Don't use available resources, i.e. food pantries, meal programs, etc. 3	Don't use available resources, i.e. food pantries, meal programs, etc. 4
Lack of transportation to food resoruces and grocery store	Lack of transportation to food resoruces and grocery store 1	Lack of transportation to food resoruces and grocery store 2	Lack of transportation to food resoruces and grocery store 3	Lack of transportation to food resoruces and grocery store 4
Lack of resources to feed children when school is not in session (no free lunch or breakfast)	Lack of resources to feed children when school is not in session (no free lunch or breakfast) 1	Lack of resources to feed children when school is not in session (no free lunch or breakfast) 2	Lack of resources to feed children when school is not in session (no free lunch or breakfast) 3	Lack of resources to feed children when school is not in session (no free lunch or breakfast) 4
Food Stamp allotment runs out	Food Stamp allotment runs out 1	Food Stamp allotment runs out 2	Food Stamp allotment runs out 3	Food Stamp allotment runs out 4
Not enough income when making use of resoruces	Not enough income when making use of resoruces 1	Not enough income when making use of resoruces 2	Not enough income when making use of resoruces 3	Not enough income when making use of resoruces 4
Not eligible for Food Stampa and/or eligibility unknown	Not eligible for Food Stampa and/or eligibility unknown 1	Not eligible for Food Stampa and/or eligibility unknown 2	Not eligible for Food Stampa and/or eligibility unknown 3	Not eligible for Food Stampa and/or eligibility unknown 4

Comments or suggestions related to this area of concern.

5. 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
Do not know about possible resources to supplement income such as food stamps, health insurance, etc.)	*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. Do not know about possible resources to supplement income such as food stamps, health insurance, etc.) 1	Do not know about possible resources to supplement income such as food stamps, health insurance, etc.) 2	Do not know about possible resources to supplement income such as food stamps, health insurance, etc.) 3	Do not know about possible resources to supplement income such as food stamps, health insurance, etc.) 4
Information about the Earned Income Tax Credit and how to claim it.	Information about the Earned Income Tax Credit and how to claim it. 1	Information about the Earned Income Tax Credit and how to claim it. 2	Information about the Earned Income Tax Credit and how to claim it. 3	Information about the Earned Income Tax Credit and how to claim it. 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
Difficult with money management, including issues with credit card debt and how to manage bank accounts.	Difficult with money management, including issues with credit card debt and how to manage bank accounts. 1	Difficult with money management, including issues with credit card debt and how to manage bank accounts. 2	Difficult with money management, including issues with credit card debt and how to manage bank accounts. 3	Difficult with money management, including issues with credit card debt and how to manage bank accounts. 4
Understanding how to set up or maintain a budget.	Understanding how to set up or maintain a budget. 1	Understanding how to set up or maintain a budget. 2	Understanding how to set up or maintain a budget. 3	Understanding how to set up or maintain a budget. 4
How to get/enforce child support.	How to get/enforce child support. 1	How to get/enforce child support. 2	How to get/enforce child support. 3	How to get/enforce child support. 4

Comments or suggestions related to this area of concern.

6. 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 - free preschool program for at-risk 3 and 4-year olds meeting income guidelines and/or facing an education-related disability.	*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. Head Start - free preschool program for at-risk 3 and 4-year olds meeting income guidelines and/or facing an education-related disability. 1	Head Start - free preschool program for at-risk 3 and 4-year olds meeting income guidelines and/or facing an education-related disability. 2	Head Start - free preschool program for at-risk 3 and 4-year olds meeting income guidelines and/or facing an education-related disability. 3	Head Start - free preschool program for at-risk 3 and 4-year olds meeting income guidelines and/or facing an education-related disability. 4
Project Discovery - encouraging high school students to continue their education.	Project Discovery - encouraging high school students to continue their education. 1	Project Discovery - encouraging high school students to continue their education. 2	Project Discovery - encouraging high school students to continue their education. 3	Project Discovery - encouraging high school students to continue their education. 4
Emergency Assistance - for low-income individuals or families facing a financial crisis.	Emergency Assistance - for low-income individuals or families facing a financial crisis. 1	Emergency Assistance - for low-income individuals or families facing a financial crisis. 2	Emergency Assistance - for low-income individuals or families facing a financial crisis. 3	Emergency Assistance - for low-income individuals or families facing a financial crisis. 4
Housing Choice Voucher (Rental Assistance) - assists low-income residents with their monthly rent payments.	Housing Choice Voucher (Rental Assistance) - assists low-income residents with their monthly rent payments. 1	Housing Choice Voucher (Rental Assistance) - assists low-income residents with their monthly rent payments. 2	Housing Choice Voucher (Rental Assistance) - assists low-income residents with their monthly rent payments. 3	Housing Choice Voucher (Rental Assistance) - assists low-income residents with their monthly rent payments. 4
Housing Counseling/Foreclosure Prevention - prepared clients for homeownership or helps them maintain their home when facing foreclosure.	Housing Counseling/Foreclosure Prevention - prepared clients for homeownership or helps them maintain their home when facing foreclosure. 1	Housing Counseling/Foreclosure Prevention - prepared clients for homeownership or helps them maintain their home when facing foreclosure. 2	Housing Counseling/Foreclosure Prevention - prepared clients for homeownership or helps them maintain their home when facing foreclosure. 3	Housing Counseling/Foreclosure Prevention - prepared clients for homeownership or helps them maintain their home when facing foreclosure. 4
Emergency Home Repair - for low-income seniors and disabled persons to make modest home repairs related to safety, sanitation, and access for disabled persons.	Emergency Home Repair - for low-income seniors and disabled persons to make modest home repairs related to safety, sanitation, and access for disabled persons. 1	Emergency Home Repair - for low-income seniors and disabled persons to make modest home repairs related to safety, sanitation, and access for disabled persons. 2	Emergency Home Repair - for low-income seniors and disabled persons to make modest home repairs related to safety, sanitation, and access for disabled persons. 3	Emergency Home Repair - for low-income seniors and disabled persons to make modest home repairs related to safety, sanitation, and access for disabled persons. 4
Energy Efficiency Education - teaches clients how to reduce their utility bills through in-home counseling.	Energy Efficiency Education - teaches clients how to reduce their utility bills through in-home counseling. 1	Energy Efficiency Education - teaches clients how to reduce their utility bills through in-home counseling. 2	Energy Efficiency Education - teaches clients how to reduce their utility bills through in-home counseling. 3	Energy Efficiency Education - teaches clients how to reduce their utility bills through in-home counseling. 4

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

7. In which county do you live:

In which county do you live: Madison

Greene

Orange

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

8. Please indicate your age range.

Please indicate your age range. 17 or under

18-24

25-44

45-64

65+

9. Please indicate your annual household income.

Please indicate your annual household income. $20,000 or less

$21,000 to $29,000

$30,000 to $49,000

$50,000 to $74,000

$75,000 to $99,000

$100,000+

10. Please indicate your household type.

Please indicate your household type. Single

Single Parent

Couple (married or unmarried)

Couple (married or unmarried) with children

Grandparents with grandchildren

Number of persons in your household:

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