This Southwestern Wisconsin Community Action Program (SWCAP) Survey is being conducted to gain a better understanding of the needs of the community members that SWCAP serves, in order to provide the best service possible. This survey is anonymous and will take between 5 and 10 minutes to complete.

Thank you for your time and participation. Your opinion is important and valued.

If you have any questions, please contact SWCAP at 1-800-704-8555.



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* 1. Please indicate your satisfaction with the following SWCAP services, if they have been used by anyone in your household?

  Very Unsatisfied Somewhat Unsatisfied Neutral Somewhat Satisfied Very Satisfied I do not use this program I am unaware of this program
Business Development
Community Emergency Services (food and assistance for homeless, matching people to services, etc)
Dental Hygiene and Referral
Foster Grandparent Program
Head Start and Early Head Start
Housing Programs
HUD Rental Assistance
LIFT Transportation Service
Neighborhood Health Partners
Representative Payee and Corporate Guardianship
Skills Enhancement
Target Hunger Venison Donation Program
SWCAP Food Pantry
SWCAP Thrift Shops (Dodgeville/ Boscobel)
Weatherization
(WIC) Women, Infants, and Children Nutrition
Work 'n Wheels

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* 2. What is your level of satisfaction with the services you've received from SWCAP?

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* 3. If SWCAP services have not been used by anyone in your household in the past three years, what are the reasons for not using the services? (Check all that apply)

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* 4. How present are these issues in your life?

  Not Present Slightly Present Very Present Not Applicable
Fearing violence from your partner.
Feeling increased levels of stress.
Having difficulty finding a dentist that accepts Medical Assistance.
Having difficulty finding a doctor that accepts Medical Assistance.
Having difficulty getting quality medical care.
Having a disability or health conditions that make it difficult to work.
Having a gambling addiction.
Having depression and/or other mental health issues.
Having difficulty affording dental care.
Having difficulty affording health care.
Having difficulty affording health insurance.
Having difficulty affording prescription drugs.
Having medical debt.
Abuse of alcohol and/or drug use by youth.
Getting physically, emotionally, and/or sexually abused.
Needing treatment for drugs or alcohol.
Dealing with your teenagers.
Lacking affordable child care.
Needing to learn parenting skills.
Being in danger of eviction/foreclosure.
Having difficulty buying a house.
Having difficulty affording heating bills.
Having difficulty affording property taxes.
Having difficulty affording rent/house payments (mortgage payments).
Living in overcrowded housing.
Needing accessible housing for people with disabilities.
Needing emergency shelter.
Needing home repairs.
Needing insulation/weatherization.
Recovering from losing your home in foreclosure.
Having debt due to a cash advance store.
Having high credit car debt.
Needing help improving my credit score.
Needing job training.
Needing jobs for teens.
Needing jobs of any kind.
Needing to learn how to manage money.
Needing well-paying jobs.
Wanting after-school or before-school programs.
Needing clothing.
Needing food.
Having difficulty accessing grocery stores and other food stores.
Needing transportation for elderly.
Needing transportation for people with disabilities.
Needing transportation to get to work or school.

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* 5. What county do you live in?

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* 6. What is your housing situation?

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* 7. Do you own your housing or do you rent?

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* 8. What is your household type?

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* 9. What are the ages of your household members (including yourself)? (Check all the apply)

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* 10. What are the genders of your household members(including yourself)? (Check all that apply)

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* 11. Do you or your household members have disabilities?

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* 12. What is your education level?

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* 13. What is your employment status?

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* 14. What is your annual household income?

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* 15. What are your sources of household income? (Check all that apply)

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* 16. Which of the following describe your financials? (Check all that apply)

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* 17. If you have borrowed money from a payday loan or cash advance service, have you ever fallen behind on your payments?

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* 18. If you have medical insurance, what type do you have? (Check all that apply)

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* 19. What is one thing that would have the greatest impact on you and your family becoming more economically self-sufficient?

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* 20. Which best describes you? (Please choose only one)

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* 21. What is your communication level in English?

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* 22. Do you have any other comments, questions, or concerns?

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* 23. Where do you most often buy your food (Check all that apply)

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* 24. How do you usually get to the store to shop for food?

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* 25. How long does it usually take to get to the store where you shop for food most often?

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* 26. Within the past 12 months, we worried whether our food would run out before we got money to get more.

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* 27. In the past 12 months, what would have made it easier for you to get your groceries? (Check all that apply)

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* 28. Do you use any of these programs?

  Often Sometimes Never I am unaware of this program
Women, Infants, and Children Program (WIC)
FoodShare / Quest card (food stamps)
Food pantries
School meals (breakfast and lunch)
School backpack program
Summer Food Service Program (open to all children under 18)
Senior meal site sand home-delivered meals
Senior Farmers Market Vouchers
Community meal programs

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* 29. Please rank the following populations in order of highest priority of those you believe that SWCAP should focus on when considering expansion of programs to increase food security (#1 HIGHEST priority and #7 LEAST priority

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* 30. What do you think would be the most effective way to help people who are struggling with hunger? (Choose 3)

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