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* 1. In what county do you live?

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* 2. How many adults (18+) live in the household?

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* 3. How many children (17 and under) live in your household?

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* 4. What is your current employment status? (check all that apply)

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* 5. What is your gender?

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* 6. What is your age?

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* 7. What is your race?

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* 8. What is your ethnicity?

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* 9. What is the highest level of education you have completed? 

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* 10. Do you currently have health insurance? 

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* 11. Is anyone in your household a veteran or currently in the military? 

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* 12. Do you rent or own?

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* 13. Tell us how you are doing? 1 - In Crisis, 2 - Vulnerable, 3 - Stable, 4 - Self-sufficient, and 5 - Thriving (check all that apply)

  1 2 3 4 5 N/A
Employment 
Income 
Household budgeting
Job training/skills
Current housing 
Health coverage 
Transportation 
Childcare 
Mental/Emotional health 
Physical health 
Alcohol/Substance dependency 
Nutrition 
Domestic Violence 
Support (family/friends) 
Legal Issues 
Pregnant/Infant care 

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* 14. What issues concern you the most in your community? ( 1 being the least concerning and 5 being most concerning)

  1 2 3 4 5 N/A
Literary skills 
Needs for job training 
Not enough jobs 
Adult education opportunities 
Homelessness 
Affordable/Lack of safe housing 
Lack of transportation 
Services for disabled family/children 
Teen Pregnancy 
Food for low-income 
Food for elderly 
Education for children 
Cost of Utilities 
Child abuse/neglect 
Substance abuse 
Domestic Violence 

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* 15. What issues concern you the most in your family? (check all that apply) 

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* 16. Was your family affected by COVID-19?

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* 17. During COVID-19 did you or anyone in your family file for unemployment?

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* 18. How did Community Action Agency meet your needs?

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* 19. Did the staff treat you with courtesy and respect?

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* 20. Please tell us the services your family received and leave any additional comments you would like. We now have a Mobile App: LITTLite. Download the app in the Apple App Store or Google Play Store and let us know what you think! 
Thank you for taking the time to complete our survey!

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