Your responses help us know who is in our community and how we may better serve you and your neighbors. Community assessments help identify the strengths and resources available in your community to meet the needs of children, youth, families, and seniors. They provide a framework for the agency in developing and identifying services and solutions to help inbuilding communities that support and nurture children and families.

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* 1. In what county do you live?

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* 2. Number of Household Members

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* 3. Age of Household Members

  Under 16 16 - 24 25 - 39 40 - 59 60 - 64 65 +
Number:

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* 4. Your Age

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* 5. Marital Status

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* 6. Race/Ethnicity

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* 7. Gender

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* 8. Education Level

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* 9. Are you employed?

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* 10. If employed, do you receive benefits with your job?

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* 11. If employed, is there opportunity to advance?

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* 12. Household Annual Income

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* 13. Have you had a lasting financial change from the economic impacts of COVID?

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* 14. Do you receive these types of income?

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* 15. Are you able to support you and your family with the monthly income you receive?

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* 16. Do you have an emergency fund or savings for unexpected expenses?

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* 17. Do you have barriers to continuing your education?

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* 18. What is your living situation?

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* 19. What is your monthly housing expense?

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* 20. What is your average monthly utility expense?

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* 21. Does your home/residence need extensive repairs?

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* 22. If Yes, What Type:

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* 23. How far do you travel for grocery store/farmer’s market?

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* 24. What language do you most often speak at home?

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* 25. How do you handle computer, e-mail, or internet use? (check all that apply)

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* 26. How do you get around? (check all that apply)

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* 27. Are there affordable childcare services in your area?

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* 28. What type of childcare do you use?

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* 29. Check off the four (4) most important needs FOR YOU and/or YOUR FAMILY

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* 30. Check off the four (4) most important needs FOR YOUR COMMUNITY

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* 31. What are the TWO MAIN barriers to employment IN YOUR COMMUNITY?

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* 32. What are the TWO MAIN barriers to reliable transportation IN YOUR COMMUNITY?

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* 33. What are the TWO MAIN barriers to health care IN YOUR COMMUNITY?

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* 34. What are the TWO MAIN barriers to healthy nutrition IN YOUR COMMUNITY?

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* 35. What are the TWO MAIN housing problems IN YOUR COMMUNITY?

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* 36. What are three (3) changes that would most improve the lives of youth IN THIS COMMUNITY?

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* 37. What are the three (3) problems that most make life difficult for adults IN THIS COMMUNITY?

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* 38. If YOU or SOMEONE YOU KNOW were experiencing these problems, would you know where or how to get help?

  Yes None Available Don't Know How
Can’t pay gas or electric bill
Can’t pay water bill
Home in foreclosure
Landlord is about to evict
Home in need of repairs

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* 39. If YOU or SOMEONE YOU KNOW were experiencing these problems, would you know where or how to get help?

  Yes None Available Don't Know How
Not enough food
Poor nutrition or unhealthy lifestyle
Dental problems
Vision problems
Prescription help

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* 40. If YOU or SOMEONE YOU KNOW were experiencing these problems, would you know where or how to get help?

  Yes None Available Don't Know How
Behavioral Health/Mental Health help
Health insurance / Medicaid / Medicare help
Substance use/abuse help
Violence in the home

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* 41. If YOU or SOMEONE YOU KNOW were experiencing these problems, would you know where or how to get help?

  Yes None Available Don't Know How
Lack of childcare or after school care
Poor reading or need for GED
Need to file unemployment
Out of work and need job search help

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* 42. If YOU or SOMEONE YOU KNOW were experiencing these problems, would you know where or how to get help?

  Yes None Available Don't Know How
Problems with transportation
Help with taxes / Earned Income Tax Credit
Bad Credit
Legal problems

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* 43. Are you MOCA Staff?

 
 100% of survey complete.

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