Community Needs Assessment

* 1. Are you Male or Female?

* 2. The total number of people living in your household?

* 3. The number of children under the age of 18 living in your home?

* 4. The number of persons in your home that are age 65 and over?

* 5. Your age category?

* 6. Your race or ethnic background?

* 7. Your household income range?

* 9. What do you feel are the major needs of your Community? (Select Two)

* 10.  What services or programs do you feel your community needs? (Select Two)

* 11. What makes it hard for you or your family members to get and keep a job? (Select Two)

* 12. What do teenagers in your area need most to prepare for the future? (Select Two)

* 13. Do you own or rent your home?

* 14. Do you have any suggestions to improve your Community Action Programs?

* 15. Health?

* 16. Education - What is the level of Education of parent of guardian? 

* 17. Employment - Are you currently employed? Or underemployed?

* 18. Is child / day care readily available and accessible to you?

* 19. Do you receive child care subsidy?

* 20. What are the top three issues currently effecting your family?

* 21. Is your child enrolled in Head Start?

* 22. Have you had any other children attend Head Start?

* 23. Were you a Head Start student?

* 24. If you were a Head Start Student do you have a College Degree?

* 25. How many years have you been involved in the Head Start Program?

* 26. Are you a grandparent raising a grandchild?

* 27. Do you participate in any leadership activities or organizations at the community, state or other level?

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