Board Member Needs Assessment Questionaire

We are currently trying to determine the needs of the people in the communities we serve and would appreciate your input.

Would you please give us your opinion on this simple survey? Please feel free to add your comments or suggestions. Thank you for your help. We value your opinion.

Question Title

* 1. Family Level Needs:

Please rank the importance of needs for low income families based on the following scale:

1: Extremely important 2: Very important 3: Moderately important
4: Slightly important 5: Not important at all

	Choose One for Each Need
Child Care Assistance	Child Care Assistance Choose One for Each Need menu
Assistance for the Elderly	Assistance for the Elderly Choose One for Each Need menu
Emergency Assistance	Emergency Assistance Choose One for Each Need menu
Assistance with Energy Costs	Assistance with Energy Costs Choose One for Each Need menu
Homeless Assistance	Homeless Assistance Choose One for Each Need menu
GED or Adult Education	GED or Adult Education Choose One for Each Need menu
Food Assistance	Food Assistance Choose One for Each Need menu
First Time Homebuyer Education	First Time Homebuyer Education Choose One for Each Need menu
Foreclosure Prevention Counseling	Foreclosure Prevention Counseling Choose One for Each Need menu
Self Sufficiency Counseling/Assistance	Self Sufficiency Counseling/Assistance Choose One for Each Need menu
Assistance with Reentry of ex-offenders	Assistance with Reentry of ex-offenders Choose One for Each Need menu
Mental Health Assistance	Mental Health Assistance Choose One for Each Need menu
Transportation	Transportation Choose One for Each Need menu
Unemployment Assistance	Unemployment Assistance Choose One for Each Need menu
Job Training	Job Training Choose One for Each Need menu
Assistance with Substance Abuse	Assistance with Substance Abuse Choose One for Each Need menu
Before or After School Activities	Before or After School Activities Choose One for Each Need menu
Dental/Vision Assistance	Dental/Vision Assistance Choose One for Each Need menu
Post-Secondary Education Supports	Post-Secondary Education Supports Choose One for Each Need menu
Budgeting/Financial Counseling	Budgeting/Financial Counseling Choose One for Each Need menu
Rental Assistance	Rental Assistance Choose One for Each Need menu

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* 2. Are there any needs not being met in low income families?

Yes

If yes, please identify those needs?

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* 3. Community Level Needs:

Please rank the importance of the following needs in your community based on the following scale:

1: Extremely important 2: Very important 3: Moderately important
4: Slightly important 5: Not important at all

	Choose One for Each Need
Affordable Housing	Affordable Housing Choose One for Each Need menu
Homeless Shelters	Homeless Shelters Choose One for Each Need menu
Food Pantries	Food Pantries Choose One for Each Need menu
Affordable Childcare	Affordable Childcare Choose One for Each Need menu
Job Creation	Job Creation Choose One for Each Need menu
Access to Affordable Healthcare	Access to Affordable Healthcare Choose One for Each Need menu
Reduction in Crime Rates	Reduction in Crime Rates Choose One for Each Need menu
Child Abuse Prevention	Child Abuse Prevention Choose One for Each Need menu
Improving Public Safety	Improving Public Safety Choose One for Each Need menu
Promoting Volunteerism within the Community	Promoting Volunteerism within the Community Choose One for Each Need menu
Availability of resources for low-income families	Availability of resources for low-income families Choose One for Each Need menu
Drug Prevention Resources	Drug Prevention Resources Choose One for Each Need menu
Transportation Resources	Transportation Resources Choose One for Each Need menu
Supports for ex-offenders	Supports for ex-offenders Choose One for Each Need menu
Educational/Training opportunities	Educational/Training opportunities Choose One for Each Need menu
Substance Abuse Rehabilitation	Substance Abuse Rehabilitation Choose One for Each Need menu
Before or After school activities	Before or After school activities Choose One for Each Need menu
Anti-poverty initiatives	Anti-poverty initiatives Choose One for Each Need menu
Elder Abuse Prevention	Elder Abuse Prevention Choose One for Each Need menu

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* 4. Are there any needs not being met in your community?

Yes

If yes, please identify those needs?

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* 5. Other Comments:

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* 6. Customer Satisfaction

Please rank the level of satisfaction with Southwest Human Resource Agency.

Excellent

Very Good

Good

Average

Below Average

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* 7. Thank you for your help. We value your opinion.

Name: (Optional)

County: (Optional)

Board Member Needs Assessment Questionaire

Question Title

* 1. Family Level Needs:Please rank the importance of needs for low income families based on the following scale: 1: Extremely important 2: Very important 3: Moderately important 4: Slightly important 5: Not important at all

Question Title

* 2. Are there any needs not being met in low income families?

Question Title

* 3. Community Level Needs: Please rank the importance of the following needs in your community based on the following scale: 1: Extremely important 2: Very important 3: Moderately important 4: Slightly important 5: Not important at all

Question Title

* 4. Are there any needs not being met in your community?

Question Title

* 5. Other Comments:

Question Title

* 6. Customer SatisfactionPlease rank the level of satisfaction with Southwest Human Resource Agency.

Question Title

* 7. Thank you for your help. We value your opinion.

* 1. Family Level Needs:

Please rank the importance of needs for low income families based on the following scale:

1: Extremely important 2: Very important 3: Moderately important
4: Slightly important 5: Not important at all

* 3. Community Level Needs:

Please rank the importance of the following needs in your community based on the following scale:

1: Extremely important 2: Very important 3: Moderately important
4: Slightly important 5: Not important at all

* 6. Customer Satisfaction

Please rank the level of satisfaction with Southwest Human Resource Agency.