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We want to hear from you — our community — to know what we are doing well and what we could do better. By completing this survey, you are helping inform local nonprofit service providers, government officials, community groups, and your neighbors about the true needs of Cape Ann’s residents.

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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. Si compara su situación con la de hace tres años, ¿usted y su familia están mejor, peor o igual?

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* 4. ¿Puede pagar sus cuentas a tiempo todos los meses?

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* 5. ¿Actualmente tiene al menos $500 separados para emergencias?

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* 6. ¿Qué impide que usted o su familia se sientan financieramente más estables? Marque TODAS las opciones que correspondan.

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* 7. ¿Cuál es su situación laboral?

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* 8. What is your housing situation?

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* 9. ¿A cuál de estos programas/servicios de Action Inc. ha accedido usted o alguien de su familia? Marque TODAS las opciones que correspondan.

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* 10. En general, ¿cómo calificaría la calidad de los servicios de Action Inc.?

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* 11. Mencione otros programas/servicios que quisiera que se ofrezcan en su comunidad:

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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.

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