Hilltown CDC Housing and Social Services Needs Survey

We would like you to have a voice in how we seek funding for hilltown services through a Community Development Block Grant by telling us where you see the greatest needs in our community. Please answer a few questions and rate the need level for each of the following items.

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* 1. What Town do you live in?

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* 2. What social services do you think are needed in the Hilltowns? (Check all that apply.)

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* 3. Do you or anyone in your household currently receive any of the following social services? (Check all that apply)

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* 4. Do you know someone in the hilltowns who could benefit from the following services? (Check all that apply)

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* 5. Please prioritize each of these needs. (Check the number from lowest to highest need.)

  1 (minimally need) 2 3 4 (highly needed)
In-home senior chore services
In-home medical senior services
Financial assistance for child care services
Food pantry
Anti-Crime programs
Health services
Mental health services
Legal services
Tenant/Landlord counseling
Services for the disabled
Veterans services
Youth services
Services for the homeless
Domestic violence assistance
Substance abuse services
HIV/AIDS services
Immigrant services

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* 6. Do you or someone you know in the hilltowns need the following services? (Check all that apply.)

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* 7. Do you need repairs completed at your home?

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* 8. If so, which type of repairs (please check all that apply)?

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* 9. How much do you think these repairs would cost?

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* 10. If you would like us to send you information regarding any of the services, please provide your name and address and tell us which services you are interested in learning more about.

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