* 1. I live in the Calhoun-Liberty communities.

* 2. Your Age:

* 3. Your Race:

* 4. Household Income:

* 5. How long have you lived in this community?

* 6. What do you love about the Calhoun-Liberty communities? (check all that apply)

* 7. Compared with 5 years ago, how would you rate your community as a place to live?

* 8. Are there children living in your household?

* 9. Are you a single parent?

* 10. Are you aware of the services and facility locations offered here?

* 11. Please indicate how problematic you feel the following issues are for your community.

  No Problem Minor Problem Moderate Problem Serious Problem
Alcohol and/or Drug Use
Access to Healthy Foods
Child Abuse
Drunk Driving
Family/Domestic Violence
Homelessness/Families Doubled Up
Inadequate Housing
Juvenile Crime
Lack of help and/or special care for elderly
Lack of Physical Activity/Exercise
No Medicaid Access Points available
Overweight and Obesity Issues
Sexual Assault
Shortage of Daycare Services
Shortage of Recreational Programs
Teen Pregnancy
Uncertainty of where to call or go for help
Youth with behavior/emotional problems

* 12. Would you like help to stop smoking?

* 13. Would you like help with substance abuse?

* 14. Would you like help with finding employment?

* 15. Would you like help for ex-offenders?

* 16. Would you like a phone number and/or website to assist with finding services?

* 17. What types of services/activities would you like to see available in the Calhoun-Liberty communities? (check all that apply)

* 18. If an OutReach/Service Center was available in our community to address such needs, would you use the services?