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.

* 1. What county do you live in?

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

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

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

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

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

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

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

* 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.

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

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

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

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

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

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

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

* 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.

* 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.

* 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.

* 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
Credit repair
Payday loans
Checking and savings accounts
Landlord/tenant issues
Car title loans (not a car purchase loan)
Rent reimbursement claims
Filing tax returns (Earned Income Tax Credit)
Property tax exemptions
Credit card debt
Home energy/utility cost issues
Budgeting or money management issues
Obtaining loans

* 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?

* 22. What do you believe causes poverty?

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

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

* 25. Any other comments?

Thank you for your participation.

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