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

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* 2. Have you ever experienced discrimination?

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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)?

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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?

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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? 

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

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* 7. What is your gender?

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* 8. What is your age?

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* 9. What is your ethnicity?

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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.

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