The purpose of this survey is to gain a better understanding of how individuals, families and children are faring in terms of having their basic economic, housing, education, health, and social needs met. Please fill out the information in Part I before going on to Part II of the survey. The information in Part 1 (below) will be kept confidential; it is being gathered for statistical purposes only.

* 1. HES

* 2. The county in which you live:

* 3. The race that best defines you:

* 4. Your gender:

* 5. Your family type:

* 6. Your educational level:

* 7. The total number of persons in your household:

* 8. The amount that best represents your annual household income:

* 9. The number of people in your household between the ages of: (Write in your answer.)

* 10. The number of disabled people in your household between the ages of: (Write in your answer.)

Please check any applicable answers in each of the areas below:

* 11. HEALTH CARE is a problem in this area because of a lack of:

* 12. EDUCATION is a problem in this area because of a lack of:

* 13. CHILD CARE (for infants up to preschoolers) is a problem in this area because of a lack of:

* 14. EMPLOYMENT is a problem in this area because of a lack of:

* 15. FINANCIAL MANAGEMENT is a problem in this area because of a lack of:

* 16. FINANCIAL LITERACY is a problem in this area because of a lack of:

* 17. TRANSPORTATION is a problem in this area because of a lack of:

* 18. HOUSING is a problem in this area because of a lack of:

* 19. FAMILY SUPPORT services are a problem in this area because of a lack of:

* 20. FOOD/NUTRITION is a problem in this area because of a lack of:

* 21. Would you recommend SHORE UP! Services to anyone else?

* 22. Would you return to use our services next season if you were still eligible?

THANK YOU
 

We appreciate you taking the time to fill out our survey and helping SHORE UP!, Inc.

develop a better understanding about current needs within the communities we serve!!
 
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