1. Delaware Opportunities Inc. 2018 Needs Assessment Survey

Delaware Opportunities is currently assessing the needs of low income residents in Delaware County.  Your input is needed to assist in telling us what your needs are, if we have met your needs, and where we can improve.  Taking this survey will allow us to compile all data collected and create a needs assessment to help us do our job better.  The survey is anonymous.  Thank you for your help!

* 1. Are you receiving services or have you received services from Delaware Opportunities programs in the past year?

* 2. How many people live in your household?

* 3. What is your sex?

* 4. What is the primary language spoken in your household?

* 5. Are you of Hispanic, Latino or Spanish origin?

* 6. What is your race?

* 7. What is your age?

* 8. What are the ages of the other people in your household?

* 10. What is the highest level of education you have completed?

* 11. What have been your household's top 3 needs within the past 12 months?  Check 3 that apply:

* 12. Check ALL services you or someone in your household needed but DID NOT receive within the past 12 months.  Check all that apply:

* 13. If you needed services, but did not receive them, what was the reason?

* 14. How did you hear about Delaware Opportunities?  Check all that apply:

* 15. Which of the following do you or other members of your household use?  Check all that apply:

* 16. What is your primary mode of transportation?  Check one that applies:

* 17. In the past 12 months, has lack of transportation been an issue for your household?

* 18. In the past 12 months, has anyone in your household experienced any of the following challenges with transportation?

  Yes No Does Not Apply
Inability to afford gas
Inability to afford car repairs
No access to a car
No car insurance
No driver's license or license suspended
Public transportation not available

* 19. How many people in your household are employed?

* 20. For the adults (18 and older) in your household who are NOT working for pay, please indicate why they do not work. Check all that apply:

* 21. What income or benefits do you or anyone living in your household have?  Check all that apply:

* 22. In the past 12 months, what was your estimated ANNUAL household income?

* 23. Do you or does anyone in your household have a benefit package through work (health insurance, etc.)?

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