* 1. Please select the County you represent:

* 2. What is your gender?

* 3. What is your age group?

* 4. What is your marital status?

* 5. What is your race?

* 6. Are you

* 7. What is your highest level of education completed?

* 8. Employment Status (Check all that apply)?

* 9. Are you

* 10. Are you

* 11. Annual household income?

The following survey questions were created to better understand community needs and issues.

* 12. Which of the following do you see as the major problems in your community? (Check all that apply.)

* 13. Which of the following EMPLOYMENT needs do you feel should be addressed in your community? (Check all that apply.)

* 14. Which of the following EDUCATION needs do you feel should be addressed in your community? (Check all that apply.)

* 15. Which of the following FINANCIAL needs do you feel should be addressed in your community? (Check all that apply.)

* 16. Which of the following HOUSING needs do you feel should be addressed in your community? (Check all that apply.)

* 17. Which of the following HEALTH needs do you feel should be addressed in your community? (Check all that apply.)

* 18. Which of the following COMMUNITY INVOLVEMENT needs do you feel should be addressed in your community? (Check all that apply.)

* 19. Which of the following TRANSPORTATION needs do you feel should be addressed in your community? (Check all that apply.)

* 20. Which of the following OTHER needs do you feel should be addressed in your community? (Check all that apply.)

* 21. If you have additional comments, please provide them in the space below. We appreciate and value your input.

WSOS would like to thank you for taking the time to give us your input.

Your input and comments provide valuable information for planning our programs and services.

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