Hispanic Advisory Community Survey

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* 1. Do you feel welcome living in Lake County?

Yes

If no why?

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* 2. Have you ever experienced discrimination?

Yes

If yes please explain

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* 3. Do you feel as though there are any barriers to receiving any type of assistance (i.e. rental, utility, medication, counseling)?

Yes

If yes please list barriers

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* 4. If there was a Hispanic group that could privately advocate on your behalf regarding community issues, would you use their services?

Yes

If no, please explain why

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* 5. Would you be interested in participating as a community member in a Hispanic Advisory Committee? This committee was designed to discuss ongoing issues that Lake County Hispanic face within our community?

Yes

If no please explain why.

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* 6. Have you ever heard or used any of the following agencies? Check all or none of the above.

Fair Housing Resource Center, Inc.

Lifeline Inc.

LakeTran

Catholic Charaties

Extended Housing

Lake Metropolitan Housing Authority

Council on Aging

Signature Health or Beacon Health

WomenSafe

Forbes House

Legal Aid

None of the above

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* 7. What is your gender?

Male

Female

Other

Non disclosed

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* 8. What is your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 9. What is your ethnicity?

Hispanic Origin

Not of Hispanic Origin

Other

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* 10. 10. Any additional comments, concerns or issues you have experienced or notice others experiencing being a Lake County Resident? If you would like to be entered into a drawing for a $50.00 Visa Gift Card please leave your name and Phone number.