Greater Cape Ann Community Needs Survey

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* 3. Compared with three years ago, are you and your family better off, worse off, or about the same?

Better off

Worse off

About the same

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* 4. Are you able to pay your bills on time each month?

Yes

Unsure

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* 5. Do you currently have at least $500 set aside for emergencies?

Yes

Unsure

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* 6. What keeps you or your family from feeling more financially stable? Check ALL that apply.

I work full-time but my pay doesn’t cover my expenses.

I can only find part-time work.

I can’t find a job.

Child care is too expensive and/or interferes with my ability to work.

My living expenses (rent/mortgage, heat, food) are too high.

I can’t find housing that I can afford.

I’ve had a lot of medical expenses that weren’t covered by my insurance.

I (or a family member) have a physical disability that prevents me from working (short- or long-term). - or disability of any kind. (response option changed after survey was closed to code data)

I don’t have reliable transportation.

I am on a fixed income (Social Security, pension, etc.), and my income is limited.

I lost eligibility for benefits (i.e., SNAP, MassHealth, DTA).

I (or a family member) am struggling with addiction.

I (or a family member) am struggling with mental health issues.

I have poor credit or no credit.

I have too much debt.

Not applicable

I cannot afford to live alone (response option added after survey was closed to code data)

Property taxes are too high or have increased (response option added after survey was closed to code data)

I have no savings/savings depleted (response option added after survey was closed to code data)

I or my spouse lost a job (response option added after survey was closed to code data)

I am caring for children or elderly relatives (response option added after survey was closed to code data)

Other:

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* 7. What is your employment status?

Full-time

Part-time

Unemployed - job searching

Unemployed - not searching

Retired

Student

Disabled (response option added after survey was closed to code data)

Working more than one job (response option added after survey was closed to code data)

Stay-at-home parent/caregiver (response option added after survey was closed to code data)

Self-employed (response option added after survey was closed to code data)

Retired and working/semi-retired (response option added after survey was closed to code data)

Seasonal/temp employment (response option added after survey was closed to code data)

Other:

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* 8. What is your housing situation?

Rental unit I can afford

Mortgage I can afford

Rental unit I can’t afford

Mortgage I can’t afford

Live with friends/family

Home I own outright

Homeless

Reverse mortgage (response option added after survey was closed to code data)

Subsidized or public housing (response option added after survey was closed to code data)

Renting from/living with family or reliant on family to pay living expenses (response option added after survey was closed to code data)

Home I "almost" can't afford (response option added after survey was closed to code data)

Home I own outright but can't afford (response option added after survey was closed to code data)

Other:

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* 9. Which of these Action Inc. programs/services have you or anyone in your family accessed? Check ALL that apply.

None/Not Applicable

Advocacy (i.e., help with benefits)

QUEST

Emergency Shelter

Housing First

Our Place

COMPASS

Adult Education

Nurse Aide Training Program

CDL Training Program

Fuel Assistance

Weatherization

Project Uplift (holiday gifts)

Other (Please specify):

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* 10. Overall, how do you rate the quality of Action Inc.’s services?

Great

Good

Fair

Poor

Unacceptable

Please explain:

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* 11. List any other programs/services you would like to see offered in your community.

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* 12. What is your age?

Under 18

18-24

25-44

45-64

65 and older

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* 13. What is your gender, as you define yourself?

Male

Female

Non-binary

Other:

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* 14. What is your race? (Please check one.)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian/Other Pacific Islander

White

Other

Multi-Race

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* 15. Are you Hispanic/Latino?

Yes

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* 16. What is your household’s monthly income before taxes?

Include: Wages, TANF, Social Security, Disability Benefits, etc. Do NOT Include: Food Stamps (SNAP), WIC, MassHealth, Other Public Health Insurance, Fuel Assistance, etc.

Under $2000/month (or under $24,000/year)

$2000 - $4000/month (or $24,000 - $48,000/year)

$4001 - $6000/month (or $48,001 - $72,000/year)

Over $6000/month (or over $72,000/year)

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* 17. How many people are in your household including yourself?

# of people age 0 – 17 years

# of people age 18 years or older

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* 18. Contact Information (optional)

If you provide contact information, you will have a chance to win one of TEN $25 Market Basket gift cards. Your contact information will not be used for any other purposes.

Name:

Phone:

Email:

Greater Cape Ann Community Needs Survey

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* 1. Where do you live?

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* 2. What do you think are the top needs impacting people in your community? Check ALL that apply.

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* 3. Compared with three years ago, are you and your family better off, worse off, or about the same?

Question Title

* 4. Are you able to pay your bills on time each month?

Question Title

* 5. Do you currently have at least $500 set aside for emergencies?

Question Title

* 6. What keeps you or your family from feeling more financially stable? Check ALL that apply.

Question Title

* 7. What is your employment status?

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* 8. What is your housing situation?

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* 9. Which of these Action Inc. programs/services have you or anyone in your family accessed? Check ALL that apply.

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* 10. Overall, how do you rate the quality of Action Inc.’s services?

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* 11. List any other programs/services you would like to see offered in your community.

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* 12. What is your age?

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* 13. What is your gender, as you define yourself?

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* 14. What is your race? (Please check one.)

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* 15. Are you Hispanic/Latino?

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* 16. What is your household’s monthly income before taxes?

Include: Wages, TANF, Social Security, Disability Benefits, etc. Do NOT Include: Food Stamps (SNAP), WIC, MassHealth, Other Public Health Insurance, Fuel Assistance, etc.

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* 17. How many people are in your household including yourself?

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* 18. Contact Information (optional)

If you provide contact information, you will have a chance to win one of TEN $25 Market Basket gift cards. Your contact information will not be used for any other purposes.

Greater Cape Ann Community Needs Survey

Question Title

* 1. Where do you live?

Question Title

* 2. What do you think are the top needs impacting people in your community? Check ALL that apply.

Question Title

* 3. Compared with three years ago, are you and your family better off, worse off, or about the same?

Question Title

* 4. Are you able to pay your bills on time each month?

Question Title

* 5. Do you currently have at least $500 set aside for emergencies?

Question Title

* 6. What keeps you or your family from feeling more financially stable? Check ALL that apply.

Question Title

* 7. What is your employment status?

Question Title

* 8. What is your housing situation?

Question Title

* 9. Which of these Action Inc. programs/services have you or anyone in your family accessed? Check ALL that apply.

Question Title

* 10. Overall, how do you rate the quality of Action Inc.’s services?

Question Title

* 11. List any other programs/services you would like to see offered in your community.

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* 12. What is your age?

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* 13. What is your gender, as you define yourself?

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* 14. What is your race? (Please check one.)

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* 15. Are you Hispanic/Latino?

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* 16. What is your household’s monthly income before taxes?Include: Wages, TANF, Social Security, Disability Benefits, etc. Do NOT Include: Food Stamps (SNAP), WIC, MassHealth, Other Public Health Insurance, Fuel Assistance, etc.

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* 17. How many people are in your household including yourself?

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* 18. Contact Information (optional)If you provide contact information, you will have a chance to win one of TEN $25 Market Basket gift cards. Your contact information will not be used for any other purposes.

* 16. What is your household’s monthly income before taxes?

Include: Wages, TANF, Social Security, Disability Benefits, etc. Do NOT Include: Food Stamps (SNAP), WIC, MassHealth, Other Public Health Insurance, Fuel Assistance, etc.

* 18. Contact Information (optional)

If you provide contact information, you will have a chance to win one of TEN $25 Market Basket gift cards. Your contact information will not be used for any other purposes.