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* 1. What county in Iowa do you live or work in?

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* 2. My current stress level is

  Low Average High
Regarding finances
Regarding employment
At home
Overall

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* 3. What are the greatest challenges your household is currently facing? (check all that apply)

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* 4. Have you or anyone in your household applied for rent, mortgage, utility, or energy assistance in the past 12 months with any helping agency? (check all that apply)

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* 5. Have you, or do you plan to, receive a COVID vaccine?

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* 6. Have you (or anyone in your household) received services from Community Action of Southeast Iowa in the past year?

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* 7. Is your current household income lower than it was before COVID?

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* 8. If your household income has reduced, have you applied for unemployment benefits at any time over the past year?

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* 9. Is your current household monthly income (the past 30 days or projected next 30 days) at or below 200% of the Federal Poverty Level (FPL)? 

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* 10. Any additional comments.

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* 11. (Optional) If you would like further information on resources please enter your email.

0 of 11 answered
 

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