2023 Community Needs Assessment Survey

Question Title

* 2. What is your role in the community?

Community Action Client/ Low Income Resident

Faith Based Organization

Private Sector

Community Organization/Partner

Educational Institution/ Staff

Health Care Agencies

Board Member of Community Action Agency

Staff or Volunteer of Community Action Agency

Local Politician/ Government/ Public Sector Rep.

Question Title

* 3. How old are you?

<20

20-24

25-39

40-59

60-64

65 +

Question Title

* 4. Marital Status

Single

Married

Divorced

Widowed

Separated

Question Title

* 5. Gender

Question Title

* 6. Race

Black/ African American

White/ Caucasian

Asian

Hispanic

Native American

Multi- Racial

Other (please specify)

Question Title

* 7. Number in Household

7 +

Question Title

* 8. Are you or anyone in your household a Veteran

Yes

Question Title

* 9. Household Income

No Cash Income

0-10,000

10,001-20,000

20,001-30,000

30,001-40,000

40,001-50,000

50,001 +

Question Title

* 10. What are the household sources of income?

Wage/ Salary

Barter/ Trade

Social Security or Social Security Disability

Side Jobs

No Income

Retirement

Question Title

* 11. What are your TOP 3 greatest expenses each month?

Question Title

* 12. Do you have savings for unexpected expenses?

Yes

Question Title

* 13. Are you able to support your family with the monthly income you receive? (Without Assistance Programs)

Yes

Question Title

* 14. Do you currently make money doing odd jobs, providing services, or bartering for mutual help with someone?

Yes

Question Title

* 15. Are you currently working?

Full- Time

Part- Time

Self- Employed

Not Working

Question Title

* 16. If not working, are you currently seeking employment? Please skip if Employed

Yes

Question Title

* 17. if not, why?

Disability

Retired

Lack of Childcare

Lack of Transportation

Gave up after not getting hired anywhere

Not qualified for available jobs (education, experience, etc.)

Question Title

* 18. Do you have running reliable transportation?

Yes

Question Title

* 19. What type of Transportation do you primarily use?

Walking

Bicycle

Friend- Carpool

Bus

Motor Vehicle (car/truck/SUV/Motorcycle/etc.)

Question Title

* 20. What is your education level?

No High School Diploma

Hi-Set/GED/High School Equivalent

Technical/ Vocational

Some College

Associates

Bachelors or Higher

Question Title

* 21. If no High School diploma, then what grade level of school did you complete? Please skip if you have a High School Diploma/ GED or Greater

K-5th

6th-8th

9-12th

None- Did not attend any schooling

Question Title

* 22. Are you currently attending College/ Technical/Vocational schooling?

Yes

Question Title

* 23. What type of childcare do you have?

Daycare

Family Member/ Friend

Early Head start/ Head Start

None

No Children- N/A

Question Title

* 24. Do you have a child currently enrolled in Preschool or Kindergarten? Please skip if you do not have children 2-6 or No Children

Yes

Question Title

* 25. Do you currently own or rent your home?

Own

Rent

None- Living with Family Friends/Homeless

Question Title

* 26. What type of housing do you live in?

House

Apartment

Duplex

Mobile Home

Shelter

None- Homeless

Question Title

* 27. Do you receive housing assistance? (i.e. Section 8, Income Based)

Yes

Question Title

* 28. Have you experienced homelessness in the past 12 months?

Yes

Question Title

* 29. Are you able to pay all your monthly utility bills without assistance? (heating/cooling)

Yes

Question Title

* 30. What energy source(s) does your home have?

Wood

Electric

Propane

Natural Gas

Cylinder Propane

None

Question Title

* 31. How far do you travel to the nearest food source? (store, food bank/pantry, etc.)

Less than 5 miles

6-10 miles

11-15 miles

16-20 miles

Over 20 miles

Question Title

* 32. Is there a food bank/pantry available within 10 miles of your home?

Yes

I don't know

Question Title

* 33. What are the nutrition issues that affect your family?

Can't afford to purchase nutritious meals

Don't know how to prepare nutritious meals

Not eligible for food stamps

Lack of transportation to get food

Lack of kitchen appliances

Food Pantry, Meals on Wheels, Community Gardens, etc. not available in my area

None

Question Title

* 34. Are you getting assistance to purchase food? (check all that apply)

Food Stamps

WIC

Free/ Reduced Lunch for Children at School

Question Title

* 35. Do you have health insurance?

Private Insurance (provided through employer or self pay)

Medicare

Medicaid

None

2023 Community Needs Assessment

North East Community Action Corporation (NECAC)

Question Title

* 1. What County do you live in?

Question Title

* 2. What is your role in the community?

Question Title

* 3. How old are you?

Question Title

* 4. Marital Status

Question Title

* 5. Gender

Question Title

* 6. Race

Question Title

* 7. Number in Household

Question Title

* 8. Are you or anyone in your household a Veteran

Question Title

* 9. Household Income

Question Title

* 10. What are the household sources of income?

Question Title

* 11. What are your TOP 3 greatest expenses each month?

Question Title

* 12. Do you have savings for unexpected expenses?

Question Title

* 13. Are you able to support your family with the monthly income you receive? (Without Assistance Programs)

Question Title

* 14. Do you currently make money doing odd jobs, providing services, or bartering for mutual help with someone?

Question Title

* 15. Are you currently working?

Question Title

* 16. If not working, are you currently seeking employment? Please skip if Employed

Question Title

* 17. if not, why?

Question Title

* 18. Do you have running reliable transportation?

Question Title

* 19. What type of Transportation do you primarily use?

Question Title

* 20. What is your education level?

Question Title

* 21. If no High School diploma, then what grade level of school did you complete? Please skip if you have a High School Diploma/ GED or Greater

Question Title

* 22. Are you currently attending College/ Technical/Vocational schooling?

Question Title

* 23. What type of childcare do you have?

Question Title

* 24. Do you have a child currently enrolled in Preschool or Kindergarten? Please skip if you do not have children 2-6 or No Children

Question Title

* 25. Do you currently own or rent your home?

Question Title

* 26. What type of housing do you live in?

Question Title

* 27. Do you receive housing assistance? (i.e. Section 8, Income Based)

Question Title

* 28. Have you experienced homelessness in the past 12 months?

Question Title

* 29. Are you able to pay all your monthly utility bills without assistance? (heating/cooling)

Question Title

* 30. What energy source(s) does your home have?

Question Title

* 31. How far do you travel to the nearest food source? (store, food bank/pantry, etc.)

Question Title

* 32. Is there a food bank/pantry available within 10 miles of your home?

Question Title

* 33. What are the nutrition issues that affect your family?

Question Title

* 34. Are you getting assistance to purchase food? (check all that apply)

Question Title

* 35. Do you have health insurance?

Question Title

* 36. Are you a registered voter?