CAPECO Community Needs Assessment Survey

CAPECO’s mission is to assist people to become independent, healthy, and safe. In order to live up this goal, CAPECO’s employees work hard developing and delivering the kinds of programs that address the issues faced by low-income citizens in our service area. Although CAPECO cannot possibly deal with all of the problems, we want to use the funds we have in the most effective way possible. We cannot do that without your help. You are the only person who understands the problems that you face daily. You are the only person who can tell us if the programs we deliver are still effective or need to be changed to deal with more current issues. You are not required to answer every question.

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* 1. What County do you live in? (check one)

Umatilla

Morrow

Gilliam

Wheeler

Sherman

Wasco

Hood River

Other

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* 2. City of residence?

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* 3. City of employment?

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* 4. Total household size? (number of people)

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* 5. Number of children in your household age 0 to 17?

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* 6. Number of adults in your household age 18 to 64?

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* 7. Number of older adults in your household over 65?

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* 8. Marital Status? (check one)

Married

Divorced/Separated

Never Married

Widowed

Other

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* 9. What is your housing situation? (check one)

I own my own home

I rent my home

I am homeless

Other (please specify)

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* 10. How old are you?

Under 18

18-24

25-35

35-44

45-54

55-64

65+

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* 11. What is your gender?

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* 12. What is your race/ethnicity?

African-America/Black

Hispanic or Latino

Multi-race

White

Asian

Native Hawaiian/Pacific Islander

Native American or Alaska Native

Prefer not to answer

Other

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* 13. Have you or anyone in your household served in the military?

Yes

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* 14. Highest level of education in your household:

0 - 8th grade

9th – 12th grade

High School diploma/GED

Certified Vocation

Associates Degree

Bachelor’s Degree

Post-Graduate Degree

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* 15. Does anyone in your household have a disability?

Yes

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* 16. Do you have a computer at home?

Yes

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* 17. Do you have an Internet connection at home?

Yes

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* 18. If you do not have internet, where do you go to use the internet? (Check all that apply)

Library

Community Center

School

Work

I do not use the internet

Other (please specify)

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* 19. Have you volunteered in the last 12 months?

Yes

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* 20. How many times have you moved in the last 12 months?

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* 21. Do you have a bank account?

Yes

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* 22. If yes, is your account balance:

Under $100

$100 - $1000

Over $1000

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* 23. Which of the following are your preferred methods of communication to receive information about your community, news in your area, job postings, etc.? (Check all that apply)

Social Media (Facebook, Twitter, etc.)

Radio

Mail

Websites

Printed publications (newspapers, flyers, etc.)

Text messages

In person (face to face)

Other (please specify)

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* 24. In general do you feel that you are:

Better off than 1 year ago

Worse off than 1 year ago

About the same

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* 25. Please select all sources of income in your household: (check all that apply)

Full-Time Employment

Part-Time Employment

Self-Employment

Unemployment

General Assistance

Social Security

Pensions

Child Support

Disability/Workers Comp.

TANF

SSI

Other (please specify)

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* 26. What is your current work status? (Check One)

Working two or more jobs

Working full-time

Working part time, in need of full-time

Not working, not looking for work

Working part time, not in need of full time

Retired

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* 27. How much income does your household have in a year?

Less than $15,000

$15,001 to $30,000

$30,001 to $50,000

$50,001 to $75,000

More than $75,000

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* 28. Check a box to indicate how frequently the following are needs for YOU and those in your HOUSEHOLD.

	Never a concern for ME or my HOUSEHOLD	Sometimes a concern for ME or my HOUSEHOLD	Often a concern for ME or my HOUSEHOLD	Always a concern for ME or my HOUSEHOLD
Finding affordable, quality housing	Finding affordable, quality housing Never a concern for ME or my HOUSEHOLD	Finding affordable, quality housing Sometimes a concern for ME or my HOUSEHOLD	Finding affordable, quality housing Often a concern for ME or my HOUSEHOLD	Finding affordable, quality housing Always a concern for ME or my HOUSEHOLD
Programs and services for seniors	Programs and services for seniors Never a concern for ME or my HOUSEHOLD	Programs and services for seniors Sometimes a concern for ME or my HOUSEHOLD	Programs and services for seniors Often a concern for ME or my HOUSEHOLD	Programs and services for seniors Always a concern for ME or my HOUSEHOLD
Being homeless	Being homeless Never a concern for ME or my HOUSEHOLD	Being homeless Sometimes a concern for ME or my HOUSEHOLD	Being homeless Often a concern for ME or my HOUSEHOLD	Being homeless Always a concern for ME or my HOUSEHOLD
Finding a job	Finding a job Never a concern for ME or my HOUSEHOLD	Finding a job Sometimes a concern for ME or my HOUSEHOLD	Finding a job Often a concern for ME or my HOUSEHOLD	Finding a job Always a concern for ME or my HOUSEHOLD
Affordable, quality dental care	Affordable, quality dental care Never a concern for ME or my HOUSEHOLD	Affordable, quality dental care Sometimes a concern for ME or my HOUSEHOLD	Affordable, quality dental care Often a concern for ME or my HOUSEHOLD	Affordable, quality dental care Always a concern for ME or my HOUSEHOLD
Local, quality dental care	Local, quality dental care Never a concern for ME or my HOUSEHOLD	Local, quality dental care Sometimes a concern for ME or my HOUSEHOLD	Local, quality dental care Often a concern for ME or my HOUSEHOLD	Local, quality dental care Always a concern for ME or my HOUSEHOLD
Immigration and citizenship issues	Immigration and citizenship issues Never a concern for ME or my HOUSEHOLD	Immigration and citizenship issues Sometimes a concern for ME or my HOUSEHOLD	Immigration and citizenship issues Often a concern for ME or my HOUSEHOLD	Immigration and citizenship issues Always a concern for ME or my HOUSEHOLD
Opportunities to learn about work, careers, and getting ahead	Opportunities to learn about work, careers, and getting ahead Never a concern for ME or my HOUSEHOLD	Opportunities to learn about work, careers, and getting ahead Sometimes a concern for ME or my HOUSEHOLD	Opportunities to learn about work, careers, and getting ahead Often a concern for ME or my HOUSEHOLD	Opportunities to learn about work, careers, and getting ahead Always a concern for ME or my HOUSEHOLD
Understanding household budgets	Understanding household budgets Never a concern for ME or my HOUSEHOLD	Understanding household budgets Sometimes a concern for ME or my HOUSEHOLD	Understanding household budgets Often a concern for ME or my HOUSEHOLD	Understanding household budgets Always a concern for ME or my HOUSEHOLD
Access to computers/Internet	Access to computers/Internet Never a concern for ME or my HOUSEHOLD	Access to computers/Internet Sometimes a concern for ME or my HOUSEHOLD	Access to computers/Internet Often a concern for ME or my HOUSEHOLD	Access to computers/Internet Always a concern for ME or my HOUSEHOLD
Affordable college or trade school	Affordable college or trade school Never a concern for ME or my HOUSEHOLD	Affordable college or trade school Sometimes a concern for ME or my HOUSEHOLD	Affordable college or trade school Often a concern for ME or my HOUSEHOLD	Affordable college or trade school Always a concern for ME or my HOUSEHOLD
Support and access to information to help me with my parenting skills	Support and access to information to help me with my parenting skills Never a concern for ME or my HOUSEHOLD	Support and access to information to help me with my parenting skills Sometimes a concern for ME or my HOUSEHOLD	Support and access to information to help me with my parenting skills Often a concern for ME or my HOUSEHOLD	Support and access to information to help me with my parenting skills Always a concern for ME or my HOUSEHOLD
Finding a job with benefits	Finding a job with benefits Never a concern for ME or my HOUSEHOLD	Finding a job with benefits Sometimes a concern for ME or my HOUSEHOLD	Finding a job with benefits Often a concern for ME or my HOUSEHOLD	Finding a job with benefits Always a concern for ME or my HOUSEHOLD
Drug or alcohol abuse	Drug or alcohol abuse Never a concern for ME or my HOUSEHOLD	Drug or alcohol abuse Sometimes a concern for ME or my HOUSEHOLD	Drug or alcohol abuse Often a concern for ME or my HOUSEHOLD	Drug or alcohol abuse Always a concern for ME or my HOUSEHOLD
Health insurance for children	Health insurance for children Never a concern for ME or my HOUSEHOLD	Health insurance for children Sometimes a concern for ME or my HOUSEHOLD	Health insurance for children Often a concern for ME or my HOUSEHOLD	Health insurance for children Always a concern for ME or my HOUSEHOLD
Health insurance for adults	Health insurance for adults Never a concern for ME or my HOUSEHOLD	Health insurance for adults Sometimes a concern for ME or my HOUSEHOLD	Health insurance for adults Often a concern for ME or my HOUSEHOLD	Health insurance for adults Always a concern for ME or my HOUSEHOLD
Affordable prescription medication	Affordable prescription medication Never a concern for ME or my HOUSEHOLD	Affordable prescription medication Sometimes a concern for ME or my HOUSEHOLD	Affordable prescription medication Often a concern for ME or my HOUSEHOLD	Affordable prescription medication Always a concern for ME or my HOUSEHOLD
Being able to afford nutritious foods	Being able to afford nutritious foods Never a concern for ME or my HOUSEHOLD	Being able to afford nutritious foods Sometimes a concern for ME or my HOUSEHOLD	Being able to afford nutritious foods Often a concern for ME or my HOUSEHOLD	Being able to afford nutritious foods Always a concern for ME or my HOUSEHOLD
Children’s education/tutoring	Children’s education/tutoring Never a concern for ME or my HOUSEHOLD	Children’s education/tutoring Sometimes a concern for ME or my HOUSEHOLD	Children’s education/tutoring Often a concern for ME or my HOUSEHOLD	Children’s education/tutoring Always a concern for ME or my HOUSEHOLD
Paying utility bills (power, gas, water)	Paying utility bills (power, gas, water) Never a concern for ME or my HOUSEHOLD	Paying utility bills (power, gas, water) Sometimes a concern for ME or my HOUSEHOLD	Paying utility bills (power, gas, water) Often a concern for ME or my HOUSEHOLD	Paying utility bills (power, gas, water) Always a concern for ME or my HOUSEHOLD
Affordable, quality health care	Affordable, quality health care Never a concern for ME or my HOUSEHOLD	Affordable, quality health care Sometimes a concern for ME or my HOUSEHOLD	Affordable, quality health care Often a concern for ME or my HOUSEHOLD	Affordable, quality health care Always a concern for ME or my HOUSEHOLD
Local quality health care	Local quality health care Never a concern for ME or my HOUSEHOLD	Local quality health care Sometimes a concern for ME or my HOUSEHOLD	Local quality health care Often a concern for ME or my HOUSEHOLD	Local quality health care Always a concern for ME or my HOUSEHOLD
Not having a driver’s license	Not having a driver’s license Never a concern for ME or my HOUSEHOLD	Not having a driver’s license Sometimes a concern for ME or my HOUSEHOLD	Not having a driver’s license Often a concern for ME or my HOUSEHOLD	Not having a driver’s license Always a concern for ME or my HOUSEHOLD
Price of gas	Price of gas Never a concern for ME or my HOUSEHOLD	Price of gas Sometimes a concern for ME or my HOUSEHOLD	Price of gas Often a concern for ME or my HOUSEHOLD	Price of gas Always a concern for ME or my HOUSEHOLD
Domestic violence	Domestic violence Never a concern for ME or my HOUSEHOLD	Domestic violence Sometimes a concern for ME or my HOUSEHOLD	Domestic violence Often a concern for ME or my HOUSEHOLD	Domestic violence Always a concern for ME or my HOUSEHOLD
Services for disabled people	Services for disabled people Never a concern for ME or my HOUSEHOLD	Services for disabled people Sometimes a concern for ME or my HOUSEHOLD	Services for disabled people Often a concern for ME or my HOUSEHOLD	Services for disabled people Always a concern for ME or my HOUSEHOLD
Veterans services	Veterans services Never a concern for ME or my HOUSEHOLD	Veterans services Sometimes a concern for ME or my HOUSEHOLD	Veterans services Often a concern for ME or my HOUSEHOLD	Veterans services Always a concern for ME or my HOUSEHOLD
Being able to afford groceries	Being able to afford groceries Never a concern for ME or my HOUSEHOLD	Being able to afford groceries Sometimes a concern for ME or my HOUSEHOLD	Being able to afford groceries Often a concern for ME or my HOUSEHOLD	Being able to afford groceries Always a concern for ME or my HOUSEHOLD
Finding a job that pays enough	Finding a job that pays enough Never a concern for ME or my HOUSEHOLD	Finding a job that pays enough Sometimes a concern for ME or my HOUSEHOLD	Finding a job that pays enough Often a concern for ME or my HOUSEHOLD	Finding a job that pays enough Always a concern for ME or my HOUSEHOLD
Being able to cook my own meals	Being able to cook my own meals Never a concern for ME or my HOUSEHOLD	Being able to cook my own meals Sometimes a concern for ME or my HOUSEHOLD	Being able to cook my own meals Often a concern for ME or my HOUSEHOLD	Being able to cook my own meals Always a concern for ME or my HOUSEHOLD
Lack of transportation to work	Lack of transportation to work Never a concern for ME or my HOUSEHOLD	Lack of transportation to work Sometimes a concern for ME or my HOUSEHOLD	Lack of transportation to work Often a concern for ME or my HOUSEHOLD	Lack of transportation to work Always a concern for ME or my HOUSEHOLD
Affordable, quality mental health care	Affordable, quality mental health care Never a concern for ME or my HOUSEHOLD	Affordable, quality mental health care Sometimes a concern for ME or my HOUSEHOLD	Affordable, quality mental health care Often a concern for ME or my HOUSEHOLD	Affordable, quality mental health care Always a concern for ME or my HOUSEHOLD
Local, quality mental health care	Local, quality mental health care Never a concern for ME or my HOUSEHOLD	Local, quality mental health care Sometimes a concern for ME or my HOUSEHOLD	Local, quality mental health care Often a concern for ME or my HOUSEHOLD	Local, quality mental health care Always a concern for ME or my HOUSEHOLD
Information about eating and living healthy	Information about eating and living healthy Never a concern for ME or my HOUSEHOLD	Information about eating and living healthy Sometimes a concern for ME or my HOUSEHOLD	Information about eating and living healthy Often a concern for ME or my HOUSEHOLD	Information about eating and living healthy Always a concern for ME or my HOUSEHOLD
Long term elderly care	Long term elderly care Never a concern for ME or my HOUSEHOLD	Long term elderly care Sometimes a concern for ME or my HOUSEHOLD	Long term elderly care Often a concern for ME or my HOUSEHOLD	Long term elderly care Always a concern for ME or my HOUSEHOLD
Home repairs (drafty windows, poor furnace, lack of insulation, etc.)	Home repairs (drafty windows, poor furnace, lack of insulation, etc.) Never a concern for ME or my HOUSEHOLD	Home repairs (drafty windows, poor furnace, lack of insulation, etc.) Sometimes a concern for ME or my HOUSEHOLD	Home repairs (drafty windows, poor furnace, lack of insulation, etc.) Often a concern for ME or my HOUSEHOLD	Home repairs (drafty windows, poor furnace, lack of insulation, etc.) Always a concern for ME or my HOUSEHOLD
Paying the rent or mortgage	Paying the rent or mortgage Never a concern for ME or my HOUSEHOLD	Paying the rent or mortgage Sometimes a concern for ME or my HOUSEHOLD	Paying the rent or mortgage Often a concern for ME or my HOUSEHOLD	Paying the rent or mortgage Always a concern for ME or my HOUSEHOLD
Criminal background or outstanding legal issues	Criminal background or outstanding legal issues Never a concern for ME or my HOUSEHOLD	Criminal background or outstanding legal issues Sometimes a concern for ME or my HOUSEHOLD	Criminal background or outstanding legal issues Often a concern for ME or my HOUSEHOLD	Criminal background or outstanding legal issues Always a concern for ME or my HOUSEHOLD
Lack of transportation for medical appointments and personal outings	Lack of transportation for medical appointments and personal outings Never a concern for ME or my HOUSEHOLD	Lack of transportation for medical appointments and personal outings Sometimes a concern for ME or my HOUSEHOLD	Lack of transportation for medical appointments and personal outings Often a concern for ME or my HOUSEHOLD	Lack of transportation for medical appointments and personal outings Always a concern for ME or my HOUSEHOLD
Access to local health professionals (doctors, nurse practitioners, etc.)	Access to local health professionals (doctors, nurse practitioners, etc.) Never a concern for ME or my HOUSEHOLD	Access to local health professionals (doctors, nurse practitioners, etc.) Sometimes a concern for ME or my HOUSEHOLD	Access to local health professionals (doctors, nurse practitioners, etc.) Often a concern for ME or my HOUSEHOLD	Access to local health professionals (doctors, nurse practitioners, etc.) Always a concern for ME or my HOUSEHOLD
Support and access to information about caring for aging relatives	Support and access to information about caring for aging relatives Never a concern for ME or my HOUSEHOLD	Support and access to information about caring for aging relatives Sometimes a concern for ME or my HOUSEHOLD	Support and access to information about caring for aging relatives Often a concern for ME or my HOUSEHOLD	Support and access to information about caring for aging relatives Always a concern for ME or my HOUSEHOLD
Language barriers	Language barriers Never a concern for ME or my HOUSEHOLD	Language barriers Sometimes a concern for ME or my HOUSEHOLD	Language barriers Often a concern for ME or my HOUSEHOLD	Language barriers Always a concern for ME or my HOUSEHOLD
Access to information to help me be an informed voter	Access to information to help me be an informed voter Never a concern for ME or my HOUSEHOLD	Access to information to help me be an informed voter Sometimes a concern for ME or my HOUSEHOLD	Access to information to help me be an informed voter Often a concern for ME or my HOUSEHOLD	Access to information to help me be an informed voter Always a concern for ME or my HOUSEHOLD

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* 29. If you have an unexpected expense who in your life can provide financial assistance? (Example: friend, parent, public assistance, bank, none, etc.)

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* 1. What County do you live in? (check one)

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* 2. City of residence?

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* 3. City of employment?

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* 4. Total household size? (number of people)

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* 5. Number of children in your household age 0 to 17?

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* 6. Number of adults in your household age 18 to 64?

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* 7. Number of older adults in your household over 65?

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* 8. Marital Status? (check one)

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* 9. What is your housing situation? (check one)

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* 10. How old are you?

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* 11. What is your gender?

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* 12. What is your race/ethnicity?

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* 13. Have you or anyone in your household served in the military?

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* 14. Highest level of education in your household:

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* 15. Does anyone in your household have a disability?

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* 16. Do you have a computer at home?

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* 17. Do you have an Internet connection at home?

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* 18. If you do not have internet, where do you go to use the internet? (Check all that apply)

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* 19. Have you volunteered in the last 12 months?

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* 20. How many times have you moved in the last 12 months?

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* 21. Do you have a bank account?

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* 22. If yes, is your account balance:

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* 23. Which of the following are your preferred methods of communication to receive information about your community, news in your area, job postings, etc.? (Check all that apply)

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* 24. In general do you feel that you are:

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* 25. Please select all sources of income in your household: (check all that apply)

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* 26. What is your current work status? (Check One)

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* 27. How much income does your household have in a year?

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* 28. Check a box to indicate how frequently the following are needs for YOU and those in your HOUSEHOLD.

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* 29. If you have an unexpected expense who in your life can provide financial assistance? (Example: friend, parent, public assistance, bank, none, etc.)

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* 30. What are you determined to accomplish in the next 12 months?

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* 31. Are there any other issues or needs that you think are very important that we did not mention? Please tell us about them.

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* 32. Is there anything else you would like us to know?