LHA Resident Opportunity & Self-Sufficiency Community Needs Assessment Survey

Household Information

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* 1. Are you an adult 18 or over?

Yes

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* 2. Are you the head of household?

Yes

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

Yes

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

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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)

Nothing

Need affordable childcare

Caring for a family member who is sick or disabled

Do not speak English well

Need computer training

Lack of transportation

Need Internet access

Need job experience

Need job training

No job opportunities

Do not have a high school diploma or GED

Do not have a college degree

Disability

Criminal record

Other (please specify)

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

GED/Adult Education

Vocational Training

Increasing income

Getting a job

Getting a better job

Computer training

Saving money

Eliminating debt

2-year college

4-year college

Trade school

Other (please specify)

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

Reading

Math

Writing

Speaking English

Reading English

Writing English

Using a computer

Other

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

Primary health care

Pediatric (child) care

Prenatal (pregnancy) care

Dental care

Health care education/prevention

Nutrition and exercise programs

Services to help alleviate stress, anxiety, depression

Assistance with daily living for elderly/disable residents

Health screening services

Substance abuse treatment

Stop smoking programs

Stop drinking programs

Transportation to heath care services

Don't know

None

Other (please specify)

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* 9. What is your gender? (choose one)

Female

Male

Other

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* 10. What is your current age?

Under 18

18-24

25-34

35-44

45-54

55-65

65 or older

	Serious Problem	Moderate Problem	Not a Problem	Does not apply to my household
Availability of job training opportunities	Availability of job training opportunities Serious Problem	Availability of job training opportunities Moderate Problem	Availability of job training opportunities Not a Problem	Availability of job training opportunities Does not apply to my household
Availability of jobs for adults	Availability of jobs for adults Serious Problem	Availability of jobs for adults Moderate Problem	Availability of jobs for adults Not a Problem	Availability of jobs for adults Does not apply to my household
Availability of jobs for youth	Availability of jobs for youth Serious Problem	Availability of jobs for youth Moderate Problem	Availability of jobs for youth Not a Problem	Availability of jobs for youth Does not apply to my household
Education	Education Serious Problem	Education Moderate Problem	Education Not a Problem	Education Does not apply to my household
Availability of child care services	Availability of child care services Serious Problem	Availability of child care services Moderate Problem	Availability of child care services Not a Problem	Availability of child care services Does not apply to my household
Lack of computer/digital literacy	Lack of computer/digital literacy Serious Problem	Lack of computer/digital literacy Moderate Problem	Lack of computer/digital literacy Not a Problem	Lack of computer/digital literacy Does not apply to my household
Lack of affordable Internet service	Lack of affordable Internet service Serious Problem	Lack of affordable Internet service Moderate Problem	Lack of affordable Internet service Not a Problem	Lack of affordable Internet service Does not apply to my household
Cost of living	Cost of living Serious Problem	Cost of living Moderate Problem	Cost of living Not a Problem	Cost of living Does not apply to my household
Income/wages	Income/wages Serious Problem	Income/wages Moderate Problem	Income/wages Not a Problem	Income/wages Does not apply to my household
Debt	Debt Serious Problem	Debt Moderate Problem	Debt Not a Problem	Debt Does not apply to my household
Financial security	Financial security Serious Problem	Financial security Moderate Problem	Financial security Not a Problem	Financial security Does not apply to my household
Availability of financial services	Availability of financial services Serious Problem	Availability of financial services Moderate Problem	Availability of financial services Not a Problem	Availability of financial services Does not apply to my household
Availability of financial counseling	Availability of financial counseling Serious Problem	Availability of financial counseling Moderate Problem	Availability of financial counseling Not a Problem	Availability of financial counseling Does not apply to my household
Elderly living assistance (62+)	Elderly living assistance (62+) Serious Problem	Elderly living assistance (62+) Moderate Problem	Elderly living assistance (62+) Not a Problem	Elderly living assistance (62+) Does not apply to my household
Physical health	Physical health Serious Problem	Physical health Moderate Problem	Physical health Not a Problem	Physical health Does not apply to my household
Mental health	Mental health Serious Problem	Mental health Moderate Problem	Mental health Not a Problem	Mental health Does not apply to my household
Seeking employment with a criminal record	Seeking employment with a criminal record Serious Problem	Seeking employment with a criminal record Moderate Problem	Seeking employment with a criminal record Not a Problem	Seeking employment with a criminal record Does not apply to my household
Obtaining a degree/diploma with a criminal record	Obtaining a degree/diploma with a criminal record Serious Problem	Obtaining a degree/diploma with a criminal record Moderate Problem	Obtaining a degree/diploma with a criminal record Not a Problem	Obtaining a degree/diploma with a criminal record Does not apply to my household
Availability of substance abuse services	Availability of substance abuse services Serious Problem	Availability of substance abuse services Moderate Problem	Availability of substance abuse services Not a Problem	Availability of substance abuse services Does not apply to my household
Need for substance abuse treatment	Need for substance abuse treatment Serious Problem	Need for substance abuse treatment Moderate Problem	Need for substance abuse treatment Not a Problem	Need for substance abuse treatment Does not apply to my household