Community Assessment Survey

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* 2. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 3. What is your relationship to our agency? (Select all that apply)

I am a current client of the Community Service Block Program or CARES

I am a former client of the Community Service Block Program or CARES

I am a current client of Section 8 Housing

I am a former client of Section 8 Housing

I am a current Head Start parent

I am a former Head Start parent

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* 4. Do you currently have a job?

Yes, full time

Yes, part time

Retired

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* 5. If Unemployed, are you currently looking for work?

Yes

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* 6. If you are unemployed, please select the reason(s) why below:

Criminal background issues

Substance abuse

Lack of skills or education

Lack of transportation

Language Barrier

Layoff or Downsizing

Learning/developmental disability

Mental Health problem

Health issues

Other (please specify)

None of the above

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* 7. Would you like help with these job-related activities? (Check all that apply)

Career assessment

Career/job training

Job search strategies

Job interviewing skills

Resume writing

Educational options

Other (please specify)

None of the above

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* 8. What is your primary concern in your COMMUNITY?

Affordable Housing

High Utilities

Employment/Unemployment

Lack of quality affordable childcare

Lack of mental health resources

Lack of before and after school programs

Other (please specify)

None of the above

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* 9. Do you have childcare needs for the following age group

0-2 years old

3-5 years old

6-12 years old

13+

None of the above

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* 10. Please choose from the list below what you consider to be the greatest needs in your community?

Lack of transportation

Lack of affordable health care

Lack of affordable childcare

Lack of business paying higher wages

Lack of affordable housing

Other (please specify)

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* 11. What type of internet access do you have at home?

Broadband

Dial-up

Only have access to the internet on my cell phone

Do not have access to the internet

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* 12. Where do you usually use the internet?

Home

Work

Library

Friend's or relative home

Other (please specify)

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* 13. What is your approximate average household income?

$0-$24,999

$25,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$124,999

$125,000-$149,999

$150,000-$174,999

$175,000-$199,999

$200,000 and up

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* 14. What is your housing status?

Own

Rent

Staying with friends or family

Homeless

Other (please specify)

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* 15. In what language do you speak most often?

Arabic

Armenian

Chinese

English

French

French Creole

German

Greek

Gujarati

Hindi

Italian

Japanese

Korean

Persian

Polish

Portuguese

Russian

Spanish

Tagalog

Urdu

Vietnamese

Other (please specify)

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* 16. Which race/ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

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* 17. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, never married

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* 18. What is the highest level of school you have completed or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

Community Assessment Survey

Nash Edgecombe Wilson Community Action Inc. formerly known as NEED, Inc.

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* 1. What County do you live in ?

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* 2. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 3. What is your relationship to our agency? (Select all that apply)

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* 4. Do you currently have a job?

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* 5. If Unemployed, are you currently looking for work?

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* 6. If you are unemployed, please select the reason(s) why below:

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* 7. Would you like help with these job-related activities? (Check all that apply)

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* 8. What is your primary concern in your COMMUNITY?

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* 9. Do you have childcare needs for the following age group

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* 10. Please choose from the list below what you consider to be the greatest needs in your community?

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* 11. What type of internet access do you have at home?

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* 12. Where do you usually use the internet?

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* 13. What is your approximate average household income?

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* 14. What is your housing status?

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* 15. In what language do you speak most often?

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* 16. Which race/ethnicity best describes you? (Please choose only one.)

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* 17. Which of the following best describes your current relationship status?

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* 18. What is the highest level of school you have completed or the highest degree you have received?