Community Needs Assessment Survey - Customer/Community/Client/Staff

Tri-County Community Action Agency, Inc. (TCCAA) is performing our triennial Community Needs Assessment. Please help us by filling out our quick survey.

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* 1. Which best describes you and your relationship with Tri-County Community Agency, Inc.?

Community Member

Customer/Client

Head Start Parent

Staff

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* 2. What county do you live in?

Harrison

Jasper

Newton

Panola

Sabine

San Augustine

Shelby

Tyler

Upshur

Angelina

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* 3. What is your age

18-24

25-34

35-44

45-54

55-64

65+

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* 4. What is your gender

Male

Female

Transgender

Prefer Not To Disclose

Other (please specify)

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* 5. What is your education level?

8th Grade or Less

Some High School

High School Diploma/GED

Technical or Occupational Certificate

Some College

Associates's Degree

Bachelor's Degree or Higher

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* 6. What is your race?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 7. What Language is spoken in your household? If "Other", please provide what language is spoken.

English

Spanish

Vietnamese

Other (please specify)

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* 8. What is your family situation?

Single Person

Two Adults - No Children

Single Parent

Two Parent Household

Non-Related Adults with Children

Multigenerational Household

Other (please specify)

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* 9. Please indicate the number of people living in your home

Other (please specify)

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* 10. Please indicate the total gross income for your entire household

$12,880 - $17,419

$17,420 - $21,959

$21,960 - $31,030

$31,040 - $40,119

$40,120 - $44,659

$44,660 - $49,199

$49,200 or more

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

Employed, working full-time

Employed, working part-time

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

Migrant Seasonal Worker

Self-Employed

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* 12. How many minor children, by age, are currently live in your household?

	0	1	2	3	4	5	6	7	N/A
17 years old	17 years old 0	17 years old 1	17 years old 2	17 years old 3	17 years old 4	17 years old 5	17 years old 6	17 years old 7	17 years old N/A
1 year old	1 year old 0	1 year old 1	1 year old 2	1 year old 3	1 year old 4	1 year old 5	1 year old 6	1 year old 7	1 year old N/A
11 years old	11 years old 0	11 years old 1	11 years old 2	11 years old 3	11 years old 4	11 years old 5	11 years old 6	11 years old 7	11 years old N/A
9 years old	9 years old 0	9 years old 1	9 years old 2	9 years old 3	9 years old 4	9 years old 5	9 years old 6	9 years old 7	9 years old N/A
16 years old	16 years old 0	16 years old 1	16 years old 2	16 years old 3	16 years old 4	16 years old 5	16 years old 6	16 years old 7	16 years old N/A
Less than 1 year old	Less than 1 year old 0	Less than 1 year old 1	Less than 1 year old 2	Less than 1 year old 3	Less than 1 year old 4	Less than 1 year old 5	Less than 1 year old 6	Less than 1 year old 7	Less than 1 year old N/A
15 years old	15 years old 0	15 years old 1	15 years old 2	15 years old 3	15 years old 4	15 years old 5	15 years old 6	15 years old 7	15 years old N/A
10 years old	10 years old 0	10 years old 1	10 years old 2	10 years old 3	10 years old 4	10 years old 5	10 years old 6	10 years old 7	10 years old N/A
8 years old	8 years old 0	8 years old 1	8 years old 2	8 years old 3	8 years old 4	8 years old 5	8 years old 6	8 years old 7	8 years old N/A
6 years old	6 years old 0	6 years old 1	6 years old 2	6 years old 3	6 years old 4	6 years old 5	6 years old 6	6 years old 7	6 years old N/A
2 years old	2 years old 0	2 years old 1	2 years old 2	2 years old 3	2 years old 4	2 years old 5	2 years old 6	2 years old 7	2 years old N/A
5 years old	5 years old 0	5 years old 1	5 years old 2	5 years old 3	5 years old 4	5 years old 5	5 years old 6	5 years old 7	5 years old N/A
12 years old	12 years old 0	12 years old 1	12 years old 2	12 years old 3	12 years old 4	12 years old 5	12 years old 6	12 years old 7	12 years old N/A
7 years old	7 years old 0	7 years old 1	7 years old 2	7 years old 3	7 years old 4	7 years old 5	7 years old 6	7 years old 7	7 years old N/A
4 years old	4 years old 0	4 years old 1	4 years old 2	4 years old 3	4 years old 4	4 years old 5	4 years old 6	4 years old 7	4 years old N/A
14 years old	14 years old 0	14 years old 1	14 years old 2	14 years old 3	14 years old 4	14 years old 5	14 years old 6	14 years old 7	14 years old N/A
13 years old	13 years old 0	13 years old 1	13 years old 2	13 years old 3	13 years old 4	13 years old 5	13 years old 6	13 years old 7	13 years old N/A
3 years old	3 years old 0	3 years old 1	3 years old 2	3 years old 3	3 years old 4	3 years old 5	3 years old 6	3 years old 7	3 years old N/A
None of the above	None of the above 0	None of the above 1	None of the above 2	None of the above 3	None of the above 4	None of the above 5	None of the above 6	None of the above 7	None of the above N/A

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* 13. What statement is true regarding your housing status?

Own

Rent

Staying with Friends/Relatives

Homeless

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* 14. Do you or anyone in your household have any of the following housing related needs? (Please select your top 5. With 5 being the most important to you and your household)

	Most Important	Somewhat Important	Important	Not as Important	Least Important	Not Imporant	N/A
Home Not Safe - Structure	Home Not Safe - Structure Most Important	Home Not Safe - Structure Somewhat Important	Home Not Safe - Structure Important	Home Not Safe - Structure Not as Important	Home Not Safe - Structure Least Important	Home Not Safe - Structure Not Imporant	Home Not Safe - Structure N/A
Need Handicap Accessibility	Need Handicap Accessibility Most Important	Need Handicap Accessibility Somewhat Important	Need Handicap Accessibility Important	Need Handicap Accessibility Not as Important	Need Handicap Accessibility Least Important	Need Handicap Accessibility Not Imporant	Need Handicap Accessibility N/A
Mortgage or Rent Assistance	Mortgage or Rent Assistance Most Important	Mortgage or Rent Assistance Somewhat Important	Mortgage or Rent Assistance Important	Mortgage or Rent Assistance Not as Important	Mortgage or Rent Assistance Least Important	Mortgage or Rent Assistance Not Imporant	Mortgage or Rent Assistance N/A
Home Repairs	Home Repairs Most Important	Home Repairs Somewhat Important	Home Repairs Important	Home Repairs Not as Important	Home Repairs Least Important	Home Repairs Not Imporant	Home Repairs N/A
Housing Not Affordable	Housing Not Affordable Most Important	Housing Not Affordable Somewhat Important	Housing Not Affordable Important	Housing Not Affordable Not as Important	Housing Not Affordable Least Important	Housing Not Affordable Not Imporant	Housing Not Affordable N/A
None of the above	None of the above Most Important	None of the above Somewhat Important	None of the above Important	None of the above Not as Important	None of the above Least Important	None of the above Not Imporant	None of the above N/A

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* 15. Do you or anyone in your household need any of the following assistance with transportation? (Please select your top 5. With 5 being the most important to you and your household)

	Most Important	Somewhat Important	Important	Not As Important	Least Important	Not Important	N/A
Transportation from someone for local area for travel	Transportation from someone for local area for travel Most Important	Transportation from someone for local area for travel Somewhat Important	Transportation from someone for local area for travel Important	Transportation from someone for local area for travel Not As Important	Transportation from someone for local area for travel Least Important	Transportation from someone for local area for travel Not Important	Transportation from someone for local area for travel N/A
Driver's License	Driver's License Most Important	Driver's License Somewhat Important	Driver's License Important	Driver's License Not As Important	Driver's License Least Important	Driver's License Not Important	Driver's License N/A
Auto Repairs	Auto Repairs Most Important	Auto Repairs Somewhat Important	Auto Repairs Important	Auto Repairs Not As Important	Auto Repairs Least Important	Auto Repairs Not Important	Auto Repairs N/A
Vehicle Registration	Vehicle Registration Most Important	Vehicle Registration Somewhat Important	Vehicle Registration Important	Vehicle Registration Not As Important	Vehicle Registration Least Important	Vehicle Registration Not Important	Vehicle Registration N/A
Assistance with Insurance	Assistance with Insurance Most Important	Assistance with Insurance Somewhat Important	Assistance with Insurance Important	Assistance with Insurance Not As Important	Assistance with Insurance Least Important	Assistance with Insurance Not Important	Assistance with Insurance N/A
Transportation with someone with a disability	Transportation with someone with a disability Most Important	Transportation with someone with a disability Somewhat Important	Transportation with someone with a disability Important	Transportation with someone with a disability Not As Important	Transportation with someone with a disability Least Important	Transportation with someone with a disability Not Important	Transportation with someone with a disability N/A
In need of a vehicle	In need of a vehicle Most Important	In need of a vehicle Somewhat Important	In need of a vehicle Important	In need of a vehicle Not As Important	In need of a vehicle Least Important	In need of a vehicle Not Important	In need of a vehicle N/A
Transportation from someone for out of town travel	Transportation from someone for out of town travel Most Important	Transportation from someone for out of town travel Somewhat Important	Transportation from someone for out of town travel Important	Transportation from someone for out of town travel Not As Important	Transportation from someone for out of town travel Least Important	Transportation from someone for out of town travel Not Important	Transportation from someone for out of town travel N/A

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* 16. Do you have reliable phone access

Yes

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* 17. Do you have access to the Internet?

Yes

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* 18. Please select what assistance you or anyone in your household receives. (Please select your top 5)

	Most Important	Somewhat Important	Important	Not As Important	Least Important	Not Important	N/A
CHIPS	CHIPS Most Important	CHIPS Somewhat Important	CHIPS Important	CHIPS Not As Important	CHIPS Least Important	CHIPS Not Important	CHIPS N/A
Medicaid	Medicaid Most Important	Medicaid Somewhat Important	Medicaid Important	Medicaid Not As Important	Medicaid Least Important	Medicaid Not Important	Medicaid N/A
Medicare	Medicare Most Important	Medicare Somewhat Important	Medicare Important	Medicare Not As Important	Medicare Least Important	Medicare Not Important	Medicare N/A
Housing Voucher (Section 8)	Housing Voucher (Section 8) Most Important	Housing Voucher (Section 8) Somewhat Important	Housing Voucher (Section 8) Important	Housing Voucher (Section 8) Not As Important	Housing Voucher (Section 8) Least Important	Housing Voucher (Section 8) Not Important	Housing Voucher (Section 8) N/A
SNAP (Food Stamps)	SNAP (Food Stamps) Most Important	SNAP (Food Stamps) Somewhat Important	SNAP (Food Stamps) Important	SNAP (Food Stamps) Not As Important	SNAP (Food Stamps) Least Important	SNAP (Food Stamps) Not Important	SNAP (Food Stamps) N/A
TANF	TANF Most Important	TANF Somewhat Important	TANF Important	TANF Not As Important	TANF Least Important	TANF Not Important	TANF N/A
WIC	WIC Most Important	WIC Somewhat Important	WIC Important	WIC Not As Important	WIC Least Important	WIC Not Important	WIC N/A
Utility Assistance	Utility Assistance Most Important	Utility Assistance Somewhat Important	Utility Assistance Important	Utility Assistance Not As Important	Utility Assistance Least Important	Utility Assistance Not Important	Utility Assistance N/A
Rental Assistance	Rental Assistance Most Important	Rental Assistance Somewhat Important	Rental Assistance Important	Rental Assistance Not As Important	Rental Assistance Least Important	Rental Assistance Not Important	Rental Assistance N/A

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* 19. Do you or anyone in your household need assistance in any of these areas? (Please select your top 5. With 5 being the most important to you and your household)

	Most Important	Somewhat Important	Important	Not As Important	Least Important	Not Important	N/A
Alcohol/Drug Abuse	Alcohol/Drug Abuse Most Important	Alcohol/Drug Abuse Somewhat Important	Alcohol/Drug Abuse Important	Alcohol/Drug Abuse Not As Important	Alcohol/Drug Abuse Least Important	Alcohol/Drug Abuse Not Important	Alcohol/Drug Abuse N/A
Anger Management	Anger Management Most Important	Anger Management Somewhat Important	Anger Management Important	Anger Management Not As Important	Anger Management Least Important	Anger Management Not Important	Anger Management N/A
Caregiver Support	Caregiver Support Most Important	Caregiver Support Somewhat Important	Caregiver Support Important	Caregiver Support Not As Important	Caregiver Support Least Important	Caregiver Support Not Important	Caregiver Support N/A
Depression/Anxiety	Depression/Anxiety Most Important	Depression/Anxiety Somewhat Important	Depression/Anxiety Important	Depression/Anxiety Not As Important	Depression/Anxiety Least Important	Depression/Anxiety Not Important	Depression/Anxiety N/A
Disability Counseling	Disability Counseling Most Important	Disability Counseling Somewhat Important	Disability Counseling Important	Disability Counseling Not As Important	Disability Counseling Least Important	Disability Counseling Not Important	Disability Counseling N/A
Elder Abuse	Elder Abuse Most Important	Elder Abuse Somewhat Important	Elder Abuse Important	Elder Abuse Not As Important	Elder Abuse Least Important	Elder Abuse Not Important	Elder Abuse N/A
Parenting Classes	Parenting Classes Most Important	Parenting Classes Somewhat Important	Parenting Classes Important	Parenting Classes Not As Important	Parenting Classes Least Important	Parenting Classes Not Important	Parenting Classes N/A
Goal Setting	Goal Setting Most Important	Goal Setting Somewhat Important	Goal Setting Important	Goal Setting Not As Important	Goal Setting Least Important	Goal Setting Not Important	Goal Setting N/A
Mental Health/Behavioral Issues	Mental Health/Behavioral Issues Most Important	Mental Health/Behavioral Issues Somewhat Important	Mental Health/Behavioral Issues Important	Mental Health/Behavioral Issues Not As Important	Mental Health/Behavioral Issues Least Important	Mental Health/Behavioral Issues Not Important	Mental Health/Behavioral Issues N/A
Financial Money Management	Financial Money Management Most Important	Financial Money Management Somewhat Important	Financial Money Management Important	Financial Money Management Not As Important	Financial Money Management Least Important	Financial Money Management Not Important	Financial Money Management N/A
Domestic Violence Abuse (Adult or Child)	Domestic Violence Abuse (Adult or Child) Most Important	Domestic Violence Abuse (Adult or Child) Somewhat Important	Domestic Violence Abuse (Adult or Child) Important	Domestic Violence Abuse (Adult or Child) Not As Important	Domestic Violence Abuse (Adult or Child) Least Important	Domestic Violence Abuse (Adult or Child) Not Important	Domestic Violence Abuse (Adult or Child) N/A
Family Conflicts	Family Conflicts Most Important	Family Conflicts Somewhat Important	Family Conflicts Important	Family Conflicts Not As Important	Family Conflicts Least Important	Family Conflicts Not Important	Family Conflicts N/A
Thoughts of Suicide (in the past 6 months)	Thoughts of Suicide (in the past 6 months) Most Important	Thoughts of Suicide (in the past 6 months) Somewhat Important	Thoughts of Suicide (in the past 6 months) Important	Thoughts of Suicide (in the past 6 months) Not As Important	Thoughts of Suicide (in the past 6 months) Least Important	Thoughts of Suicide (in the past 6 months) Not Important	Thoughts of Suicide (in the past 6 months) N/A
Making Decisions/Problem Solving	Making Decisions/Problem Solving Most Important	Making Decisions/Problem Solving Somewhat Important	Making Decisions/Problem Solving Important	Making Decisions/Problem Solving Not As Important	Making Decisions/Problem Solving Least Important	Making Decisions/Problem Solving Not Important	Making Decisions/Problem Solving N/A
Additional Education	Additional Education Most Important	Additional Education Somewhat Important	Additional Education Important	Additional Education Not As Important	Additional Education Least Important	Additional Education Not Important	Additional Education N/A
Housing Assistance	Housing Assistance Most Important	Housing Assistance Somewhat Important	Housing Assistance Important	Housing Assistance Not As Important	Housing Assistance Least Important	Housing Assistance Not Important	Housing Assistance N/A
English as a Second Language (ESL)	English as a Second Language (ESL) Most Important	English as a Second Language (ESL) Somewhat Important	English as a Second Language (ESL) Important	English as a Second Language (ESL) Not As Important	English as a Second Language (ESL) Least Important	English as a Second Language (ESL) Not Important	English as a Second Language (ESL) N/A

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* 20. Do you or anyone in your household need help with these healthcare needs? (Please select your top 5. With 5 being the most important to you and your household)

	Most Important	Somewhat Important	Important	Not As Important	Least Important	Not Important	N/A
Adult with Disability	Adult with Disability Most Important	Adult with Disability Somewhat Important	Adult with Disability Important	Adult with Disability Not As Important	Adult with Disability Least Important	Adult with Disability Not Important	Adult with Disability N/A
AIDS/HIV Risk	AIDS/HIV Risk Most Important	AIDS/HIV Risk Somewhat Important	AIDS/HIV Risk Important	AIDS/HIV Risk Not As Important	AIDS/HIV Risk Least Important	AIDS/HIV Risk Not Important	AIDS/HIV Risk N/A
Child with Disability	Child with Disability Most Important	Child with Disability Somewhat Important	Child with Disability Important	Child with Disability Not As Important	Child with Disability Least Important	Child with Disability Not Important	Child with Disability N/A
Dental Care	Dental Care Most Important	Dental Care Somewhat Important	Dental Care Important	Dental Care Not As Important	Dental Care Least Important	Dental Care Not Important	Dental Care N/A
Diabetes	Diabetes Most Important	Diabetes Somewhat Important	Diabetes Important	Diabetes Not As Important	Diabetes Least Important	Diabetes Not Important	Diabetes N/A
Eye/Vision Care	Eye/Vision Care Most Important	Eye/Vision Care Somewhat Important	Eye/Vision Care Important	Eye/Vision Care Not As Important	Eye/Vision Care Least Important	Eye/Vision Care Not Important	Eye/Vision Care N/A
General Medical Care	General Medical Care Most Important	General Medical Care Somewhat Important	General Medical Care Important	General Medical Care Not As Important	General Medical Care Least Important	General Medical Care Not Important	General Medical Care N/A
Hearing Aid Care	Hearing Aid Care Most Important	Hearing Aid Care Somewhat Important	Hearing Aid Care Important	Hearing Aid Care Not As Important	Hearing Aid Care Least Important	Hearing Aid Care Not Important	Hearing Aid Care N/A
Heart Disease	Heart Disease Most Important	Heart Disease Somewhat Important	Heart Disease Important