Please take a moment to help Proteus design different programs and services by completing this survey. 

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* 1. Which of the following best describes you?

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* 2. Race/Ethnicity:

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* 3. Age:

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* 4. Gender:

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* 5. Number of people in your home.

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* 6. How many under 18 years?

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* 7. Total Annual Household Income.

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* 8. What city/town do you live in?

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* 9. What is your employment status?

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* 10. What is your education level?

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* 11. Marital Status

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* 12. What is your housing status?

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* 13. Which of the following categories best describes your household composition?

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* 14. What type of services are you currently using in your community?  Select all that apply.

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* 15. What type of services do you feel are needed in your community? (List all that you believe apply).

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* 16. Are you currently participating in any parent or community groups?

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* 17. Has anyone in your household received services through Proteus, Inc. within the last 2 years? (check all that apply).

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* 18. Which of the following barriers prevent or hinder you from seeking assistance with your basic needs?  (check all that apply).

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* 19. Do you have access to the Internet?

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* 20. Do you have a computer to use at home?

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* 21. Do you have any of the following education related needs?  (check all that apply).

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* 22. What do you feel are the biggest issues facing our community?

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* 23. Do you have suggestions or ideas of programs or activities to solve some of these issues?

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