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* 1. Are you an adult 18 or over?

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* 2. Are you the head of household?

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* 3. Does anyone in your household have physical or mental disability?

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* 4. How would you rate the following issues for your household?

  Serious Problem Moderate Problem Not a Problem Does not apply to my household
Availability of job training opportunities
Availability of jobs for adults
Availability of jobs for youth
Education
Child care services
Cost of living
Income/Wages
Debt
Financial Security
Availability of Financial Services
Availability of Financial Counseling
Elderly living assistance (62+)
Availability of health care
Health of residents
Seeking employment with a criminal record
Obtaining a degree/diploma with a criminal record
Substance abuse services
Substance abuse treatment

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* 5. What are the things that make it difficult for you or other adults in your household to find and/or keep work? (check all that apply)

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* 6. Do you or any others in your household have interest in the following? (check all that apply)

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* 7. Do you or another adult in your household have difficulty with any of the following? (check all that apply)

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* 8. What are the primary health care needs of your household? (check all that apply)

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