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The following survey will take less than 5 minutes to complete and will assist us in helping better meet the needs of your community.

All information is confidential, and your name is not required.
No identifying information will be shared with government agencies, landlords, health insurance companies, families, etc. 

Thank you for helping us help others!

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* 1. Which of the following best describes your relationship with Community Action Council? (check one)

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* 2. What is your gender? (check one)

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* 3. What is your age?

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* 4. What is your race? (check one)

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* 5. What is your ethnicity? (check all that apply)

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* 6. In which county do you live or stay? (check one)

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* 7. What ages are the children in your household? Please select all that apply.

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* 8. HOUSING
What are the most critical community needs? (check all that apply)

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* 9. INCOME AND ASSET BUILDING
What are the most critical community needs? (check all that apply)

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* 10. EMPLOYMENT
What are the most critical community needs? (check all that apply)

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* 11. EDUCATION
What are the most critical community needs? (check all that apply)

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* 12. HEALTH
What are the most critical community needs? (check all that apply)

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* 13. CIVIC ENGAGEMENT
What are the most critical community needs? (check all that apply)

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