Blue Ridge Community Action Agency cares about the entire community and is dedicated to helping people help themselves and each other. Please take a moment to complete this survey to help us understand the challenges that currently prevent you from being economically secure. The following questionnaire will only take a few minutes to complete and it will assist our agency in helping people, meeting the community needs, and providing hope.  All information will be kept confidential and your name is not required on the questionnaire.  THANK YOU FOR YOUR TIME!
Please answer these questions from your point of view:

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* 1. In which county do you live?

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* 2. What is your gender?

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* 3. What is your age?

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* 4. What is your race?

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* 5. What is your ethnicity?

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* 6. What is the primary language spoken in your home?

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* 7. What your annual household income?

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* 8. What type of income does your household receive?
   (Check all that apply)

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* 9. What is your household type?

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* 10. What is your household size?

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* 11. What is your education level?

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* 12. What is your military status?

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* 13. If you are employed, please select the following that best describes your situation. 

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* 14. If you are not employed, please select the following that best describes your situation. Check as many that apply:

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* 15. Pick what best describes your housing situation.

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* 16. When it comes to housing costs, check all that apply:

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* 17. When it comes to education, please select as many that apply:

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* 18. When it comes to health, select all that apply:

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* 19. When it comes to transportation, please select all that apply:

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* 20. When it comes to Income and asset building, please select all that apply:

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* 21. When it comes to nutrition, please select all that apply:

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* 22. If you have a car, please select all that apply:

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* 23. My community offers the following:

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* 24. What else do you think we at Blue Ridge Community Action should know so that we can help individuals and families achieve economic security and create strong, thriving communities?

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* 25. If you are currently struggling with any of the things on this survey, wherein your community are you likely to go for help?

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* 26. If you have received services from our agency in the past, which services did you receive?

We appreciate your time in completing this survey!

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* 27. If you would like to be entered into a drawing to win a gift card (One winner per county?) please provide us with the following information:

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