This survey is being conducted by Downeast Community Partners (DCP).  We are a non-profit Community Action Agency located in Washington and Hancock counties.  Our mission is to improve the quality of life and reduce the impact of poverty in Downeast communities.  DCP does this by providing services such as Head Start, fuel assistance, home repair and weatherization and transportation in the community.  The results of this survey will be used to make improvements in the services throughout Washington and Hancock counties.  Surveys received by Friday, October 30, 2020 4:30 pm will be included in the results.  We estimate the survey will take 10 minutes.

This survey is anonymous and your answers are confidential.  If you have any questions regarding this survey or its intended use, please contact Stacy Brown at (207) 610-5949 or stacy.brown@downeastcommunitypartners.org  Please fill out this survey only once, but feel free to forward this survey to a friend!

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* 1. I am responding from the perspective of a:  (Please check all that apply)

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* 2. Which town do you live in? (If homeless, name town you slept in last night)

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* 3. Are you disabled?

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* 4. Type of residence

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* 5. How many people live in your household?

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* 6. The number of children in my household that are 5 years or younger

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* 7. The number of children in my household that are ages 6-17

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* 8. Are you a grandparent or family member raising another family member’s child(ren)?

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* 9. What is your age?

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* 10. What is your race?

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* 11. What is your gender?

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* 12. Are you employed? (Please check all that apply)

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* 13. I am unemployed or underemployed because:  (Please check all that apply)

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* 14. Check the highest level of education you have completed

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* 15. Please check which is true for your total household income

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* 16. During a typical month, I have enough money to pay my monthly bills.

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* 17. I am or a member of my household is a US Veteran or an active service member.

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* 18. Members in my household have health insurance (Please check all that apply)

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* 19. Health insurance is provided by:  (Please check all that apply)

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* 20. Does your household have access to internet? (Please check all that apply)

The purpose of this section is to help DCP understand the needs of you and your household.  This information helps our agency know what sorts of services we should provide to best meet the needs of those in our communities.

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* 21. Have you used any of these educational services in the past year or anticipate needing the following services in the next year?

  Yes, I used this service No, did not need service I would benefit from this service
Employment Services
Adult Education or training programs
Income Tax preparation
Help establishing or improving credit score
Financial literacy
Literacy services
Help in learning to speak or write in English

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* 22. Have you used any of these housing services in the past year or anticipate needing the following services in the next year?

  Yes, I used this service No, did not need service I would benefit from this service
Home weatherization services
Housing loans or home buyer education
Housing repairs
Rental assistance
Financial assistance with heating oil or utilities

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* 23. Have you used any of these community services in the past year or anticipate needing the following services in the next year?

  Yes, I used this service No, did not need service I would benefit from this service
Food pantry, community meals, soup kitchen
Transportation services for work
Transportation services for medical
General transportation services
Legal services
Income tax preparation
Child care
Elder care
Youth development services
Family planning

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* 24. I have the following support systems available to me when I need them.  (Please check all that apply)

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* 25. Do you have access to a medical doctor?  If not, why?  (Please check all that apply)

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* 26. Do you have access to enough food to feed your family?  If not, why?  (Please check all that apply)

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* 27. If you need childcare, do you have access to childcare you need? (Please check all that apply)

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* 28. Do you have access to reliable transportation?  If not, why?  (Please check all that apply)

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* 29. I have access to stable, affordable housing. (Please check all that apply)

Your opinion on the Community, and you are almost done!
The purpose of this section is to get your opinion on the needs of your County

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* 30. What County do you live in?

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* 31. I believe the biggest problem facing youth in my County is:

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* 32. I believe the biggest problem facing adults in my County is:

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* 33. I believe the biggest strength in my county is:

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* 34. Please rate your level of concern for each of the following in your county by marking the box you feel best matches your thoughts for each row:

  Not a problem Minor problem Moderate problem Major problem Critical problem
The needs of the increasing elderly population
The availability and cost of quality childcare
Opportunities and supports for people and families affected by or convicted of crimes
Educational opportunities or apprenticeships/internships to obtain skills/trades training for available jobs
People living in rural parts of the county can’t easily access resources in the larger communities
Opioid Use
Obesity
Food insecurity
Mental health needs of infants and children
Poverty throughout generations in families
Grandparents and relatives raising children
Available transportation services throughout the county
Access to affordable housing

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* 35. Are there any other needs that you believe are a high priority for your County?

Thank you for completing this survey!  The data that DCP is able to compile from this survey will be a very powerful tool to the agency and the community moving forward to address issues facing our community.

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* 36. If you would like to be identified for this survey, please tell us your name and address.

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