Needs Assessment Survey

Illinois's community action agencies are conducting a study of the needs of low-income people. Results from the study will be considered by Illinois's community action agencies for planning, developing and delivering agency
activities, services and initiatives.

Instructions:

Please answer each question by checking the appropriate box or boxes. If a question does not apply to you, please leave it blank. "Community" is defined as the neighborhood and/or city in which you live.

What county do you live in?

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* 1. What county do you live in?

What community stakeholder group do you belong to? Select the answer that best describes your group.

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* 2. What community stakeholder group do you belong to? Select the answer that best describes your group.

Are there full-time living wage employment ($15 per hour or higher) opportunities available in your
community?

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* 3. Are there full-time living wage employment ($15 per hour or higher) opportunities available in your
community?

Why do you believe people have problems getting or keeping a full-time living wage job? Select all that apply.

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* 4. Why do you believe people have problems getting or keeping a full-time living wage job? Select all that apply.

Are child care programs (during the day, Monday through Friday) for low-income families available
in your community?

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* 5. Are child care programs (during the day, Monday through Friday) for low-income families available
in your community?

Are child care programs (evenings, nights and weekends) for low-income families available in your
community.

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* 6. Are child care programs (evenings, nights and weekends) for low-income families available in your
community.

Are preschool programs (including Head Start programs) for low-income families available in your
community?

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* 7. Are preschool programs (including Head Start programs) for low-income families available in your
community?

Are affordable child and youth (ages 5 to 17) activities or after school programs available in your
community?

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* 8. Are affordable child and youth (ages 5 to 17) activities or after school programs available in your
community?

In your community, in which areas do you believe youth (ages 12 to 17) need information, education, guidance and/or assistance? Select all that apply.

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* 9. In your community, in which areas do you believe youth (ages 12 to 17) need information, education, guidance and/or assistance? Select all that apply.

Are there adequate levels of non-medical emergency services available in your community?

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* 10. Are there adequate levels of non-medical emergency services available in your community?

Are there a sufficient number of emergency shelters available in your community?

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* 11. Are there a sufficient number of emergency shelters available in your community?

Are there adequate levels of medical services available for low-income people in your community?

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* 12. Are there adequate levels of medical services available for low-income people in your community?

Are there adequate levels of dental services available for low-income people in your community?

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* 13. Are there adequate levels of dental services available for low-income people in your community?

Are there adequate levels of wellness (nutrition, exercise, etc.) programs available for low-income
people in your community?

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* 14. Are there adequate levels of wellness (nutrition, exercise, etc.) programs available for low-income
people in your community?

Are there adequate levels of public transportation options (cabs, taxis, buses, trolleys, etc.) available in your community?

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* 15. Are there adequate levels of public transportation options (cabs, taxis, buses, trolleys, etc.) available in your community?

Are the homes in your area in good repair?

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* 16. Are the homes in your area in good repair?

Which of the following issues do you believe are the greatest challenges low-income families and individuals are currently facing? Select all that apply.

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* 17. Which of the following issues do you believe are the greatest challenges low-income families and individuals are currently facing? Select all that apply.

Which of the following areas do you believe low-income families and individuals need assistance with in order to achieve or maintain self-sufficiency? Select all that apply.

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* 18. Which of the following areas do you believe low-income families and individuals need assistance with in order to achieve or maintain self-sufficiency? Select all that apply.

Which of the following areas do you believe the elderly (seniors) in your community need assistance with in order to remain in their home? Select all that apply.

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* 19. Which of the following areas do you believe the elderly (seniors) in your community need assistance with in order to remain in their home? Select all that apply.

Of the following, which of these do you believe low-income families and individuals need information, education, guidance and/or assistance:

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* 20. Of the following, which of these do you believe low-income families and individuals need information, education, guidance and/or assistance:

  Yes No Unsure
Landlord/tenant issues
Credit card debt
Credit repair
Home energy/utility cost issues
Filing tax returns (Earned Income Tax Credit)
Checking and savings accounts
Payday loans
Car title loans (not a car purchase loan)
Property tax exemptions
Obtaining loans
Budgeting or money management issues
Rent reimbursement claims
On a scale of 1 to 5 (1=poor/poorly, 3=fine/adequate and 5=excellent) please rate the following:

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* 21. On a scale of 1 to 5 (1=poor/poorly, 3=fine/adequate and 5=excellent) please rate the following:

  1 2 3 4 5 Unsure
How would you rate your relationship with the community action agency in your community?
How well is the community action agency in your community meeting the needs of low-income families and individuals?
What do you believe causes poverty?

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* 22. What do you believe causes poverty?

What community improvement initiative would you like your community to address?

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* 23. What community improvement initiative would you like your community to address?

If you had $1, 000, 000 to solve a community issue, what would you solve?

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* 24. If you had $1, 000, 000 to solve a community issue, what would you solve?

Any other comments?

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* 25. Any other comments?

Thank you for your participation.

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