North East Community Action Corporation (NECAC) 

This project/program is 100% at 1,050 with federal funds received
from the U.S. Department of Health and Human Services (HHS)
provided by the Missouri Department of Social Services, Family
Services Division

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* 2. What is your role in the community?

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* 3. How old are you? 

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* 4. Marital Status

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* 6. Race 

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* 7. Number in Household

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* 8. Household Income 

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* 9. What are the household sources of income? 

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* 10. Rank your household expenses from least to greatest ( 1 being the least expensive and 5 being the most expensive)

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* 11. Do you have an emergency fund available for unexpected expenses?  

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* 12. Are you currently working? 

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* 13. Are you able to support your family with the monthly income you receive? 

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

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* 15. If you are working, is there opportunity to advance or make more money in your current job?

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* 16. If not working, are you currently seeking employment? 

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* 17. if not, why?

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* 18. What is your education level?

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* 19. If no diploma, then what grade level of school did you complete? 

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* 20. Do you have a vocational or technical training certificate?

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* 21. Are you interested in receiving more education? 

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* 22. What type of childcare do you have? (if applicable) 

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* 23. Do you think transportation is a barrier to getting and/or keeping a job? 

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* 24. Do you have running reliable transportation?

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* 25. How many times a week do you rely on public or other (walking, bicycle, friend) transportation? 

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* 26. What type of other transportation do you use? 

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

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

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

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

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* 31. Do you think there is a lack of emergency/transitional housing? 

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* 32. Do you think there is a need for more pre-purchase home-ownership education?

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* 33. Do you think there is a need for financial fitness education? 

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* 34. If you are interested in becoming a homeowner, what is a barrier you face? (check all that apply) 

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* 35. Do you think there is a need for more family housing in your community? 

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* 36. If yes, what type? (to question 35)

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* 37. Do you think there is a need for more senior housing in your community?

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* 38. If yes, what type? (to question 37)

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* 39. Do you think there is a need for more home repair programs? 

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* 40. Are you able to pay all your monthly utility bills? (heating/cooling)

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* 41. What is your primary heat source? 

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

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

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* 44. What are the top 3 nutrition issues that affect your family?

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

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* 46. Do you feel there is need for more Women's Healthcare

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* 47. Do you feel there is need for more affordable dental and vision care? 

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* 48. Do you think teen pregnancy is a problem in your community? 

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* 49. Do you feel there is a need for more in-home health services?

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* 50. Do you know an elderly/disabled person who could benefit from in-home services? 

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* 51. Do you feel elderly are aware of the services available to them? 

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* 52. Do you know someone who is below age 60 and is over income for Medicaid? 

0 of 52 answered
 

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