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* 1. What city do you reside in?

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* 2.  Family Assessment - On a scale of 1=Not at all Serious to 5=Extremely Serious, how serious a problem do you think these factors are for families in your community? Employment

  1=Not at all serious 2=Somewhat Serious 3=Moderately Serious 4=Serious 5=Extremely Serious
Adults are unemployed and do not earn a living wage.
Youth lack employment to gain skills or income.
Employment issues due to COVID-19

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* 3. Family Assessment - Education and Cognitive Development

  1=Not at all serious 2=Somewhat Serious  3=Moderately Serious  4=Serious 5=Extremely Serious
Adults lack a basic education.
Individuals lack a high school diploma or an equivalency certificate.
Individuals lack a recognized credential, certificate, or degree relating to the achievement of educational or vocational skills.
Individuals lack an Associate's degree
Individuals lack a Bachelor's degree.
Education issues due to COVID-19

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* 4. Family Assessment - Income and Asset Building

  1=Not at all serious  2=Somewhat Serious  3=Moderately Serious  4=Serious  5=Extremely Serious 
Individuals lack savings accounts.
Individuals lack savings to purchase an asset
Individuals lack savings to purchase a home.
Individuals have low credit scores.
Individuals have a low net worth.
There are a lot of Predatory lenders and/or lending practices in the community.
Income and Asset Building issues due to COVID-19

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* 5. Family Assessment - Housing

  1=Not at all serious  2=Somewhat Serious  3=Moderately Serious  4=Serious  5=Extremely Serious 
Individuals are homeless.
Individuals lack safe and affordable housing.
Individuals lack safe housing due to domestic violence.
Housing issues due to COVID-19

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* 6. Family Assessment - Health and Social Behaviors

  1=Not at all serious  2=Somewhat Serious  3=Moderately Serious  4=Serious  5=Extremely Serious 
Individuals lack nutritional skills (e.g. cooking, shopping, and growing food).
Individuals lack physical health and well-being.
Individuals lack mental and behavioral health and well-being.
Health issues due to COVID-19

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* 7. Family Assessment - Support Services

  1=Not at all serious  2=Somewhat Serious  3=Moderately Serious  4=Serious  5=Extremely Serious 
Individuals lack emergency assistance services (e.g. rent, utilities, food).
Individuals lack Veteran services.
Individuals lack elder care services.
Support Service issues due to Covid-19

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* 8. Please rank the problems that our community is currently facing in order of importance.

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* 9. What is your age?

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* 10. What is your gender?

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* 11. What is your race/ethnic origin?

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* 12. What was your household total income for last year?

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* 13. What is your education level?

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* 14. What is your employment status?

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* 15. How many adults live in your household?

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* 16. How many children live in your household?

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* 17. How many children are under the age of 5?

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* 18. What is your marital status?

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* 19. Which of the following best describes the type of housing in which you live?

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* 20. Are you Disabled?

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* 21. Are you a Veteran?

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* 22. What is your 5 digit zip code?

0 of 22 answered
 

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