Client Survey v2 Please answer the following questions to help us understand your legal needs. Question Title * 1. Please look at the following list of problems and check if you or someone you know experienced that specific problem in the last 12 months. 1. Eviction or threat of eviction 2. Landlord shut off utilities (water or electric) or locked you out of your home. 3. Problems with getting title to a mobile home that you already paid for. 4. Foreclosure on home mortgage. 5. Problems with a landlord. 6. Difficulty finding affordable housing. 7. Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability). 8. Tax problems (issues with the IRS or county property taxes). 9. Problem getting a home mortgage, small business loan or other loan 10. Denial of medical care by a doctor or hospital due to lack of insurance 11. Problems related to debt (garnishments, overdue bills, personal bankruptcy, and collectors calling frequently). 12. Exploitation or abuse of a senior citizen. 13. Issues faced by or in caring for a senior citizen. 14. Difficulties with your child’s school / education (disability, suspension, expulsion, access to alternative schooling, IEPs). 15. Problem regarding public benefits (food stamps, disability benefits through Social Security, Medicaid or Medicare). 16. Job discrimination (in hiring or on the job due to disability, race, religion, gender, national origin or sexual orientation/gender identify). 17. Problems with worker’s compensation or unemployment insurance 18. Barriers (such as lack of child care or transportation) to participating in work and training programs. 19. Child custody / visitation problems. 20. Divorce or family break up. 21. Domestic violence. 22. Problems related to making or receiving child support payments 23. Problems related to immigration or naturalization 24. Criminal record preventing employment 25. Victim of human trafficking (e.g. cannot safely quit a job, working to pay off a debt instead of pay, employer holding on to identification documents) Other (please specify) Question Title * 2. If you answered checked off any of the above, please describe: Question Title * 3. Was legal help sought out for these problems? Yes No If not, why? Question Title * 4. Please select the top 5 legal problems that you think low income individuals and families face. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Eviction or threat of eviction 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Landlord shut off utilities (water or electric) or locked you out of your home. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problems with getting title to a mobile home that you already paid for. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Foreclosure on home mortgage. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problems with a landlord. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Difficulty finding affordable housing. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Tax problems (issues with the IRS or county property taxes). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problem getting a home mortgage, small business loan or other loan 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Denial of medical care by a doctor or hospital due to lack of insurance 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problems related to debt (garnishments, overdue bills, personal bankruptcy, and collectors calling frequently). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Consumer fraud (e.g. telemarketing scam, identify theft, fake product). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Exploitation or abuse of a senior citizen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Issues faced by or in caring for a senior citizen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Difficulties with your child’s school / education (disability, suspension, expulsion, access to alternative schooling, IEPs). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problem regarding public benefits (food stamps, disability benefits through Social Security, Medicaid or Medicare). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Job discrimination (in hiring or on the job due to disability, race, religion, gender, national origin or sexual orientation/gender identify). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problems with worker’s compensation or unemployment insurance 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Barriers (such as lack of child care or transportation) to participating in work and training programs. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Child custody / visitation problems. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Divorce or family break up. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Domestic violence. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problems related to making or receiving child support payments 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Problems related to immigration or naturalization 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Criminal record preventing employment 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Victim of human trafficking (e.g. cannot safely quit a job, working to pay off a debt instead of pay, employer holding on to identification documents) Question Title * 5. Have there been other times during the past year that you thought you might need a lawyer, but didn’t get help from one? Yes No If so, describe? Question Title * 6. What has prevented you or someone you know from seeking out legal assistance for the problem? Didn’t know there was a legal issue or possible solution Wasn’t sure who to call Couldn’t find anyone I could afford I spoke to a lawyer but he or she refused to help I couldn’t get to the lawyer’s office Language or cultural problems Fear Other If "Fear" or "Other" was chosen, please explain what you mean by those answers. Question Title * 7. What specific suggestions or ideas do you have to make it easier to access legal help? Question Title * 8. At Florida Rural Legal Services, our current service priorities are housing stabilization, income maintenance, education, family law, and helping individuals get back into the work force through driver’s license restoration and expungement and sealing of criminal records. We also have a focus on senior issues helping them with end of life planning and managing the legal issues specific to their community like Medicaid eligibility and senior exploitation. As the pandemic spreads, thousand of low income families and seniors are going to need help, not just with medical issues, but also with legal issues. Can you identify the pressing issues affecting your community during this crisis? Question Title * 9. Do you feel our current priorities are going to meet the needs of the communities you serve? Why or Why not? Question Title * 10. What County do you live in? Charlotte DeSoto Glades Hardee Hendry Highlands Lee Martin Okeechobee Palm Beach Polk St. Lucie Question Title * 11. What is your race? White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race Question Title * 12. What is your Gender? Male Female Question Title * 13. What is your age? 18-40 41-59 60+ Question Title * 14. What is your annual household income? Less than $12,000 $12,000-$25,000 $25,001-$39,999 $40,000 + Done