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* 1. Are you or someone in your household looking to obtain a GED/HSED

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* 2. Are you or someone in your household looking to attend college or a training program?

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* 3. Which of the following categories best describes your current employment status?

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* 4. What is your housing status?

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* 5. Do you and/or your family have health Insurance?

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* 6. Do you have a primary doctor/ or clinic?

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* 7. What type of Health Insurance Provider do you have?

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* 8. Nutrition: Please check all that apply

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* 9. What are the community’s challenges to you?  Please choose all that apply.

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* 10. If you could improve one aspect of your community, what would it be and why?

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* 11. What is your zip code?

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