The Community Assistance Network ("CAN") is conducting a Community Needs Assessment to help CAN and our partners better understand the needs and resources in the Baltimore County community. THANK YOU for participating in this survey to support this effort!
Please only complete one survey per family.

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* 1. Gender: How do you identify?

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* 2. What is your age range?
(circle

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* 3. What is your race or ethnicity?

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* 4. Which of the following best describes your current relationship status?

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* 5. What is the highest level of school you have completed or the highest degree you have received?

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* 6. How many people currently live in your home?

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* 7. How many families currently live in your home?

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* 8. How many children, by age, currently live in your home?  Please enter the numbers below:

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* 9. Check if you are a:

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* 10. What Zip Code do you live in?

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* 11. What town or city do you live in?

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* 12. Please choose the option that most closely describes your living
situation

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* 13. Please check all that best describes you

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* 14. Would additional training help to change your employment status or income?

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* 15. If you answered "Yes" to Question 14, what kind of training would help?

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* 16. What is your total household income?

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* 17. Have you ever been homeless?

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* 18. If you answered "Yes" to Question 17, what might have helped prevent
this situation?

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* 19. If you answered "Yes" to Question 17, which of the following situations contributed to your
housing situation (choose all that apply)

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* 20. Have you ever been in a situation where you had to stay with
friends or family because you did not have a place of your own?

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* 21. If you answered "Yes" to Question 20, what caused your housing situation (choose all that apply)?

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* 22. If you had an emergency or an unexpected expense, do you have savings or access to funds that you could use?

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* 23. . Do you feel safe in your home?

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* 24. . Do you feel safe in your neighborhood?

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* 25. Is there a local market that sells fresh fruits & vegetables
within walking distance of where you live?

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* 26. Have you been feeling worried, upset or sad in the last month?

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* 27. If you answered yes to Question 26, did you get help from anyone (check all that apply)?

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* 28. BEFORE the COVID pandemic, what were the three biggest issues you or your family faced?

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* 29. Did the COVID pandemic change the things that you were most concerned about?

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* 30. What are your three biggest concerns NOW?

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* 31. What are the three biggest issues facing people in your community?

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* 32. What are three things that would make your life or your
community better?

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* 33. Are you familiar with the Community Assistance Network (CAN)?

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* 34. What other local organizations provide assistance in your community?

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* 35. Have you or any family member or friend ever received
assistance from Community Assistance Network (CAN)?

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* 36. What other local organizations have provided assistance to you or any family member/friend?

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* 37. What support do you think is most needed in your community (please choose up to three)?

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