Terrebonne Parish Community Needs Assessment Survey

Question Title

* 1. Age

Under 20

20-24

25-35

36-59

60-64

65-79

80+

Question Title

* 2. Race

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

Bi-Racial/Multi Racial

Other

Question Title

* 3. Income

No Income

Less than $15,000

$15,001 and $30,000

$30,001 and $45,000

$45,001 and $60,000

more than $60,001

Question Title

* 4. City/Town Currently Live

Bourg

Chauvin

Donner

Dulac

Gibson

Gray

Houma

Montegut

Schriever

Theriot

Thibodaux

Question Title

* 5. What is your gender?

Female

Male

Question Title

* 6. Number in Household

Question Title

* 7. How many children are in the household?

Question Title

* 8. Please answer the questions below.

	Yes	No
Does your family use any food pantry or commodity program?	Does your family use any food pantry or commodity program? Yes	Does your family use any food pantry or commodity program? No
Does your family presently receive SNAP (food stamps)?	Does your family presently receive SNAP (food stamps)? Yes	Does your family presently receive SNAP (food stamps)? No
Does your family presently receive food from WIC (Women, Infants and Children)?	Does your family presently receive food from WIC (Women, Infants and Children)? Yes	Does your family presently receive food from WIC (Women, Infants and Children)? No

Question Title

* 9. Assistance

	Dont Know	No Needed	Rarely Needed	Needed	Greatly Needed
Help with applying for Social Security, SSDI	Help with applying for Social Security, SSDI Dont Know	Help with applying for Social Security, SSDI No Needed	Help with applying for Social Security, SSDI Rarely Needed	Help with applying for Social Security, SSDI Needed	Help with applying for Social Security, SSDI Greatly Needed
Prescription assistance	Prescription assistance Dont Know	Prescription assistance No Needed	Prescription assistance Rarely Needed	Prescription assistance Needed	Prescription assistance Greatly Needed
Food	Food Dont Know	Food No Needed	Food Rarely Needed	Food Needed	Food Greatly Needed
Public transportation vouchers	Public transportation vouchers Dont Know	Public transportation vouchers No Needed	Public transportation vouchers Rarely Needed	Public transportation vouchers Needed	Public transportation vouchers Greatly Needed
Free/affordable legal services	Free/affordable legal services Dont Know	Free/affordable legal services No Needed	Free/affordable legal services Rarely Needed	Free/affordable legal services Needed	Free/affordable legal services Greatly Needed

Question Title

* 10. Community

	Don't Know	Not Needed	Rarely Needed	Needed	Greatly Needed
Neighborhood clean-up projects	Neighborhood clean-up projects Don't Know	Neighborhood clean-up projects Not Needed	Neighborhood clean-up projects Rarely Needed	Neighborhood clean-up projects Needed	Neighborhood clean-up projects Greatly Needed
Crime awareness or crime reduction	Crime awareness or crime reduction Don't Know	Crime awareness or crime reduction Not Needed	Crime awareness or crime reduction Rarely Needed	Crime awareness or crime reduction Needed	Crime awareness or crime reduction Greatly Needed
Public parks and facilities	Public parks and facilities Don't Know	Public parks and facilities Not Needed	Public parks and facilities Rarely Needed	Public parks and facilities Needed	Public parks and facilities Greatly Needed
Recreational opportunities	Recreational opportunities Don't Know	Recreational opportunities Not Needed	Recreational opportunities Rarely Needed	Recreational opportunities Needed	Recreational opportunities Greatly Needed

Question Title

* 11. Education

	Don't Know	Not Needed	Rarely Needed	Needed	Greatly Needed
GED classes	GED classes Don't Know	GED classes Not Needed	GED classes Rarely Needed	GED classes Needed	GED classes Greatly Needed
English as a Second Language Classes	English as a Second Language Classes Don't Know	English as a Second Language Classes Not Needed	English as a Second Language Classes Rarely Needed	English as a Second Language Classes Needed	English as a Second Language Classes Greatly Needed
Computer Skills Training for Adults	Computer Skills Training for Adults Don't Know	Computer Skills Training for Adults Not Needed	Computer Skills Training for Adults Rarely Needed	Computer Skills Training for Adults Needed	Computer Skills Training for Adults Greatly Needed
Financial assistance to attend career tech, or college	Financial assistance to attend career tech, or college Don't Know	Financial assistance to attend career tech, or college Not Needed	Financial assistance to attend career tech, or college Rarely Needed	Financial assistance to attend career tech, or college Needed	Financial assistance to attend career tech, or college Greatly Needed

Question Title

* 12. Employment

	Don't Know	Not Needed	Rarely Needed	Needed	Greatly Needed
Help to improve job skills, training	Help to improve job skills, training Don't Know	Help to improve job skills, training Not Needed	Help to improve job skills, training Rarely Needed	Help to improve job skills, training Needed	Help to improve job skills, training Greatly Needed
Job search assistance	Job search assistance Don't Know	Job search assistance Not Needed	Job search assistance Rarely Needed	Job search assistance Needed	Job search assistance Greatly Needed
Higher paying jobs	Higher paying jobs Don't Know	Higher paying jobs Not Needed	Higher paying jobs Rarely Needed	Higher paying jobs Needed	Higher paying jobs Greatly Needed

Question Title

* 13. Family Support

	Don't Know	Not Needed	Rarely Needed	Needed	Greatly Needed
Financial Education/Budgeting	Financial Education/Budgeting Don't Know	Financial Education/Budgeting Not Needed	Financial Education/Budgeting Rarely Needed	Financial Education/Budgeting Needed	Financial Education/Budgeting Greatly Needed
Parenting Information	Parenting Information Don't Know	Parenting Information Not Needed	Parenting Information Rarely Needed	Parenting Information Needed	Parenting Information Greatly Needed
Finding Affordable Child Care	Finding Affordable Child Care Don't Know	Finding Affordable Child Care Not Needed	Finding Affordable Child Care Rarely Needed	Finding Affordable Child Care Needed	Finding Affordable Child Care Greatly Needed
Nutrition Education/Healthy Eating	Nutrition Education/Healthy Eating Don't Know	Nutrition Education/Healthy Eating Not Needed	Nutrition Education/Healthy Eating Rarely Needed	Nutrition Education/Healthy Eating Needed	Nutrition Education/Healthy Eating Greatly Needed
Classes on relationships,	Classes on relationships, Don't Know	Classes on relationships, Not Needed	Classes on relationships, Rarely Needed	Classes on relationships, Needed	Classes on relationships, Greatly Needed
resolving conflicts	resolving conflicts Don't Know	resolving conflicts Not Needed	resolving conflicts Rarely Needed	resolving conflicts Needed	resolving conflicts Greatly Needed
Programs for young children (0-11)	Programs for young children (0-11) Don't Know	Programs for young children (0-11) Not Needed	Programs for young children (0-11) Rarely Needed	Programs for young children (0-11) Needed	Programs for young children (0-11) Greatly Needed
Programs and Activities for Youth ( 12-18)	Programs and Activities for Youth ( 12-18) Don't Know	Programs and Activities for Youth ( 12-18) Not Needed	Programs and Activities for Youth ( 12-18) Rarely Needed	Programs and Activities for Youth ( 12-18) Needed	Programs and Activities for Youth ( 12-18) Greatly Needed
Programs and Activities for Seniors (65+)	Programs and Activities for Seniors (65+) Don't Know	Programs and Activities for Seniors (65+) Not Needed	Programs and Activities for Seniors (65+) Rarely Needed	Programs and Activities for Seniors (65+) Needed	Programs and Activities for Seniors (65+) Greatly Needed

Question Title

* 14. Housing

	Don't Know	Not Needed	Rarely Needed	Needed	Greatly Needed
Finding affordable housing	Finding affordable housing Don't Know	Finding affordable housing Not Needed	Finding affordable housing Rarely Needed	Finding affordable housing Needed	Finding affordable housing Greatly Needed
Help paying rent or utility bills	Help paying rent or utility bills Don't Know	Help paying rent or utility bills Not Needed	Help paying rent or utility bills Rarely Needed	Help paying rent or utility bills Needed	Help paying rent or utility bills Greatly Needed
Homeless shelter/transitional housing	Homeless shelter/transitional housing Don't Know	Homeless shelter/transitional housing Not Needed	Homeless shelter/transitional housing Rarely Needed	Homeless shelter/transitional housing Needed	Homeless shelter/transitional housing Greatly Needed
Making homes more energy efficient	Making homes more energy efficient Don't Know	Making homes more energy efficient Not Needed	Making homes more energy efficient Rarely Needed	Making homes more energy efficient Needed	Making homes more energy efficient Greatly Needed

Question Title

* 15. Health

	Don't Know	Not Needed	Rarely Needed	Needed	Greatly Needed
Health Insurance/ Affordable Medical Care	Health Insurance/ Affordable Medical Care Don't Know	Health Insurance/ Affordable Medical Care Not Needed	Health Insurance/ Affordable Medical Care Rarely Needed	Health Insurance/ Affordable Medical Care Needed	Health Insurance/ Affordable Medical Care Greatly Needed
Health Education Services	Health Education Services Don't Know	Health Education Services Not Needed	Health Education Services Rarely Needed	Health Education Services Needed	Health Education Services Greatly Needed
Mental health counseling services	Mental health counseling services Don't Know	Mental health counseling services Not Needed	Mental health counseling services Rarely Needed	Mental health counseling services Needed	Mental health counseling services Greatly Needed
Substance abuse counseling/treatment	Substance abuse counseling/treatment Don't Know	Substance abuse counseling/treatment Not Needed	Substance abuse counseling/treatment Rarely Needed	Substance abuse counseling/treatment Needed	Substance abuse counseling/treatment Greatly Needed

Terrebonne Parish Community Needs Assessment Survey

Question Title

* 1. Age

Question Title

* 2. Race

Question Title

* 3. Income

Question Title

* 4. City/Town Currently Live

Question Title

* 5. What is your gender?

Question Title

* 6. Number in Household

Question Title

* 7. How many children are in the household?

Question Title

* 8. Please answer the questions below.

Question Title

* 9. Assistance

Question Title

* 10. Community

Question Title

* 11. Education

Question Title

* 12. Employment

Question Title

* 13. Family Support

Question Title

* 14. Housing

Question Title

* 15. Health

Question Title

* 16. Rank each of the areas based on your opinion of greatest need: from 1 to 5 with 5 representing the greatest need for services.