Community Action Development Corporation

P.O. Box 989

Frederick, OK 73542

5803355588 cadcok.org

Community Needs Assessment Survey 
Opportunities regularly conducts surveys to determine what the needs are in your community so we will know where to best focus our efforts and funding.  Your help in completing this survey is sincerely appreciated.

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* 1. What City do you live in?

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* 2. What County do you live in?

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* 3. What is your zip code?

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* 4. What is your gender?

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* 5. What is your ethnicity?

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* 6. What is your race?

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* 7. What is your highest level of education completed?

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* 8. What best describes your household?

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* 9. ENTER IN THE NUMBER of persons for each age group in your household.

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* 10. What is the primary language spoken in the home?

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* 11. Is anyone in your household a veteran?

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* 12. Anyone in your household receive disability benefits?

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* 13. What was your total household income last year?

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* 14. Mark the choice that best describes you:

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* 15. What are the MOST important program/services you would you like to see continued in your community?

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* 16. How much does each item rate as a need in your community?

NUTRITION

  No Need Some Need Great Need Don't Know
Availability/access to food (grocery store)
Community Gardens
Nutrition Education/ Healthy Eating
Need Food

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* 17. How much does each item rate as a need in your community?

EMPLOYMENT

  No Need Some Need Great Need Don't Know
Job Training
Help finding a job
Higher Paying Jobs or Jobs with Benefits

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* 18. How much does each item rate as a need in your community?

HEALTH

  No Need Some Need Great Need Don't Know
Health Insurance/ Affordable Health Care
Health Education Services
Mental Health Services
Substance Abuse Counseling/Treatment
RX (prescription assistance)
Child Immunizations
Teenage Pregnancy/ Family Planning
Elder Care
Vision
Dental Insurance/ Affordable Dental

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* 19. How much does each item rate as a need in your community?

LINKAGES

  No Need Some Need Great Need Don't Know
Prisoner Discharge Services
Public Transportation
Vehicle Repair Assistance
Access to Services (WIC, SNAP, SSI, Sooner Care)

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* 20. How much does each item rate as a need in your community?

INCOME MANAGEMENT 

  No Need Some Need Great Need Don't Know
Free Income Tax Preparation Assistance
Gambling Counseling
Budget/Credit/Debit Counseling

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* 21. How much does each item rate as a need in your community?
Education

  No Need Some Need Great Need Don't Know
Early Childhood Education Programs
GED Classes
English as a Second-Language Classes
Computer Skills Training
Literacy Classes
Technical and Vocational Training
Childcare

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* 22. How much does each item rate as a need in your community?
Housing

  No Need Some Need Great Need Don't Know
Decent affordable houses to RENT
Decent affordable houses to BUY
Weatherization (Home Energy Improvement)
Home Repair
Home Buyer Education
Handicap Accessibility Housing
Senior Citizens Housing
Rental Assistance
Utility Assistance

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* 23. How much does each item rate as a need in your community?

COMMUNITY

  No Need Some Need Great Need Don't Know
Safe Neighborhoods, sidewalks, parks
Homeless Shelter
Senior Activities
Recreational Activities
Youth Activities
Crime Prevention
Additional Health Care Facilities (Doctor’s Offices, Clinics, Pharmacies)
Legal Assistance
Volunteer Opportunities

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* 24. Please describe any other need that was not listed above:

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* 25. Are you employed?

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* 26. Is your employment?

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* 27. Are you or someone one in your household an expectant mother? 

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* 28. Are you and your children experiencing homelessness? 

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* 29. How many children in your care are experiencing homelessness?

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* 30. Are you caring for foster children?

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* 31. If you marked that you have a child(ren) diagnosed with a disability, please select which disability describes your child best. Mark all that apply. 

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* 32. Are you and/ or child(ren) that have disabilities receiving services? 

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* 33. Do you feel you and your family have adequate social support?

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* 34. Does your family receive Public Assistance? (SNAP, SSI, TANF)

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* 35. What are your family's typical work schedule?

  6AM-10AM 10AM-2PM 2PM-6PM 6PM-10PM 10PM-2AM 2AM-6AM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 36. What are your family's typical school schedule?

  6AM-10AM 10AM-2PM 2PM-6PM 6PM-10PM 10PM-2AM 2AM-6AM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 37. What are your family's typical training schedule?

  6AM-10AM 10AM-2PM 2PM-6PM 6PM-10PM 10PM-2AM 2AM-6AM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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100% of survey complete.

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