Lake Cumberland Community Action Agency, Inc. Community Needs Assessment Question Title * 1. Are you Male or Female? Male Female Question Title * 2. The total number of people living in your household? 1 2 3 4 5 6 7 8 9 or more Question Title * 3. The number of children under the age of 18 living in your home? 0 1 2 3 4 5 6 7 8 Question Title * 4. The number of persons in your home that are age 65 and over? 0 1 2 3 4 5 6 7 8 Question Title * 5. Your age category? 0-16 17-24 25-34 35-44 45-54 55-64 65 or more Question Title * 6. Your race or ethnic background? Black (not Hispanic) White (not Hispanic) Hispanic origin Native American Asian origin Other (please specify) Question Title * 7. Your household income range? $0-$10,000 $10,001-$16,000 $16,001- or more Question Title * 8. The County in which you live? Adair Casey Clinton Cumberland Green McCreary Pulaski Russell Taylor Wayne Question Title * 9. What do you feel are the major needs of your Community? (Select Two) How to budget the money that is received (income management). Jobs in the community that pay a living wage (employment). Decent, affordable housing for families to rent or buy. Sufficient education. Awareness of programs and services available to improve the quality of life. Our community needs more youth programs. Families need more guidance on how to become self-sufficient. Assistance with health concerns. Emergency assistance Nutritional workshops, meal preparation. People are not involved enough to make our Community a better place to live (linkages). Question Title * 10. What services or programs do you feel your community needs? (Select Two) Adult education programs Budget training (income management) Emergency financial assistance programs for rent/mortgage/utilities Low rent housing programs Volunteer programs (Linkages) Job training programs (Employment) Nutrition programs/food banks Case managers that explain services available in my community Programs that help families become self sufficient Opportunities for the Youth in our community Programs that assist families with obtaining the health care they need Question Title * 11. What makes it hard for you or your family members to get and keep a job? (Select Two) No training or job skills Lack of transportation Lack of motivation Health problems Child care Discrimination Other (please specify) Question Title * 12. What do teenagers in your area need most to prepare for the future? (Select Two) Self-esteem Money for College Good grades in school Job training/work experience Encouragement/support Other (please specify) Question Title * 13. Do you own or rent your home? I rent my home I own my home I rent my home with government assistance (Section 8 or public housing) Question Title * 14. Do you have any suggestions to improve your Community Action Programs? Question Title * 15. Health? Do you have insurance? Do you have a primary care physician? Do you have a family dentist? Does your family receive regular dental check-ups? Question Title * 16. Education - What is the level of Education of parent of guardian? Grade School High School Diploma GED Two year College Degree Four year College Degree Currently attending college or trade school Question Title * 17. Employment - Are you currently employed? Or underemployed? Full-time Part-time Currently unemployed (If you are currently unemployed). How Long? Question Title * 18. Is child / day care readily available and accessible to you? Yes No Question Title * 19. Do you receive child care subsidy? Yes No Question Title * 20. What are the top three issues currently effecting your family? Food Education Nutrition Clothing Employment Unemployment Housing Utility Payments Transportation Health Care Mental Health Affordable Child Care Dental Care Vision Care Question Title * 21. Is your child enrolled in Head Start? Yes No Question Title * 22. Have you had any other children attend Head Start? Yes No Question Title * 23. Were you a Head Start student? Yes No Question Title * 24. If you were a Head Start Student do you have a College Degree? Yes No Question Title * 25. How many years have you been involved in the Head Start Program? I have not been involved. List the number of years. Question Title * 26. Are you a grandparent raising a grandchild? Yes No Question Title * 27. Do you participate in any leadership activities or organizations at the community, state or other level? Yes No Done