FACT 2016-17 Needs Assessment Parent Survey ENGLISH

100% of survey complete.

Would you please help us? The Family and Children’s Trust Committee (FACT) funds community agencies that provide valuable services to families like yours. In order to be sure that FACT is supporting services that are most important for you and your family, we are asking you to complete this short survey. We will use the information to recommend funding for programs that make a difference for your family and your community. You do not need to identify yourself in the survey. Thank you for participating!

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* 1. Where did you get this survey from?

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* 2. Which 3 services below are MOST important to you and your family? (Please rank no more than 3.)

	1st highest need	2nd highest need	3rd highest need
After school programs	After school programs 1st highest need	After school programs 2nd highest need	After school programs 3rd highest need
Bullying prevention	Bullying prevention 1st highest need	Bullying prevention 2nd highest need	Bullying prevention 3rd highest need
Drug and alcohol services for families	Drug and alcohol services for families 1st highest need	Drug and alcohol services for families 2nd highest need	Drug and alcohol services for families 3rd highest need
Family crisis support	Family crisis support 1st highest need	Family crisis support 2nd highest need	Family crisis support 3rd highest need
Family support and referral services	Family support and referral services 1st highest need	Family support and referral services 2nd highest need	Family support and referral services 3rd highest need
Family violence prevention	Family violence prevention 1st highest need	Family violence prevention 2nd highest need	Family violence prevention 3rd highest need
Foster/kinship support	Foster/kinship support 1st highest need	Foster/kinship support 2nd highest need	Foster/kinship support 3rd highest need
Gang prevention	Gang prevention 1st highest need	Gang prevention 2nd highest need	Gang prevention 3rd highest need
LGBTQ services	LGBTQ services 1st highest need	LGBTQ services 2nd highest need	LGBTQ services 3rd highest need
Mental health services for families	Mental health services for families 1st highest need	Mental health services for families 2nd highest need	Mental health services for families 3rd highest need
Parenting education	Parenting education 1st highest need	Parenting education 2nd highest need	Parenting education 3rd highest need
Services for families who are homeless	Services for families who are homeless 1st highest need	Services for families who are homeless 2nd highest need	Services for families who are homeless 3rd highest need
Support for children with special needs and their families	Support for children with special needs and their families 1st highest need	Support for children with special needs and their families 2nd highest need	Support for children with special needs and their families 3rd highest need
Teen parenting support	Teen parenting support 1st highest need	Teen parenting support 2nd highest need	Teen parenting support 3rd highest need
Other (please explain below)	Other (please explain below) 1st highest need	Other (please explain below) 2nd highest need	Other (please explain below) 3rd highest need

Other (please specify)

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* 3. Which of the below prevent you and your family from receiving needed services? (Please rank no more than two.)

	1. Barrier	2. Barrier
Lack of childcare	Lack of childcare 1. Barrier	Lack of childcare 2. Barrier
Cost of the services	Cost of the services 1. Barrier	Cost of the services 2. Barrier
Hours the services are offered	Hours the services are offered 1. Barrier	Hours the services are offered 2. Barrier
Language or cultural humility	Language or cultural humility 1. Barrier	Language or cultural humility 2. Barrier
Long waitlist	Long waitlist 1. Barrier	Long waitlist 2. Barrier
Services are not available	Services are not available 1. Barrier	Services are not available 2. Barrier
Lack of transportation	Lack of transportation 1. Barrier	Lack of transportation 2. Barrier

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* 4. Which of these best describes you?

Parent

Single Parent

Foster Parent

Legal Guardian

Grandparent or other relative

Community Member

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* 5. With what race or ethnic group do you most identify?

African-American / Black

American Indian/Alaska Native

Asian

Hispanic or Latino

Pacific Islander

White

More than one ethnicity

Prefer not to say

Other (please specify):

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* 6. What is your zip code?

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* 7. What is your gender?

Female

Male

Prefer not to say

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* 8. What are the ages of the children in your home?

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Thank you so much for your assistance.

All of the information from people like you will help us develop the best possible programs for families.