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* 1. Where do you live?

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* 2. What is your age?

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* 3. What is your gender, as you define yourself?

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* 4. Which most accurately portrays your race? (Please check one)

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* 5. Are you Hispanic/Latino?

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* 6. What is your household’s yearly income before taxes?

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* 7. How many people are in your household including yourself?

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* 8. How many people in your household are:

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* 9. What is your highest level of education?

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* 10. What is your employment status?

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* 11. Do you need transportation to get to: 

(Check all that apply)

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* 12. What transportation is available to you now?

(Check all that apply)

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* 13. What's preventing you from getting where you need to go?

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* 14. Are you getting housing assistance? (e.g. Section 8, subsidized housing, RAFT)

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* 15. How much do you pay each month for your rent or mortgage?

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* 16. Have you been late once or more with your rent or mortgage payment in the last year?

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* 17. Regarding childcare, check all that apply:

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* 18. Does anyone in your household access mental health or addiction support services? (e.g. Brien Center, ICP, CSO)

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* 19. How do you access health care?

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* 20. Does anyone in your household access adult basic education services? (e.g. ESOL, HiSet or GED, Adult Basic Education)

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* 21. Does anyone in your household access adult higher education services? (e.g. college, post-secondary school, professional certifications)

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* 22. How many adults living in your household are currently employed?

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* 23. To meet my needs:

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* 24. Do you need access to job training to get a job or a better job?

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* 25. In the past 12 months, did you receive any government assistance? (SNAP, TANF, SSI, etc)

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* 26. Are you living paycheck to paycheck?

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* 27. At any time during the past year did you have trouble putting food on the table?

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* 28. Over the past year have you received any services from BCAC?

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* 29. What is your household's monthly income before taxes?

Include:
Wages, TANF, Social Security, Disability Benefits, etc.

Do not Include:
Food Stamps (SNAP), WIC, MassHealth, Other Public Health Insurance, Fuel Assistance, etc.

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* 30. What is your age?

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* 31. What do you think are the top needs impacting people in your community?

Please Check ALL that apply!

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* 32. Compared with three years ago, are you and your family better off, worse off, or about the same?

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* 33. Are you able to pay your bills on time each month?

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* 34. Do you currently have at least $500 set aside for emergencies?

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* 35. What keeps you or your family from feeling more financially stable?

Check ALL that apply:

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* 36. Do you have any other comments, questions, or concerns?

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100% of survey complete.

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