Community Survey

Douglas County Community and Resource Services prepared this survey to better understand the needs of Douglas County residents. Your answers will help us prioritize how funds will be spent in the county throughout the next three years. Individual responses will remain confidential. Survey results will be included in the Community Needs Assessment, which will be available for public comment in the Summer 2017.

Please answer the questions for your current household, which includes everyone living in the household at this time. We consider your household or home to be where you currently live.

Surveys must be submitted no later than March 31, 2017.

Community Services

* 1. Which best describes your current situation?

* 2. In the last year, how many times have you needed the assistance of others to meet your basic needs?

* 3. In the last year, have you ever had trouble paying for any of the following? Check all that apply.

* 4. Have you or anyone in your household received services within the past year from non-profit organizations or government entity? Check all that apply.

* 5. Which one of the following services would most likely help you improve your current situation?

* 6. Please rank (number 1, 2 and 3) the top three services that you feel would help residents in Douglas County obtain and maintain self-sufficiency:

* 7. Did anything prevent you from accessing the services you needed? Check all that apply.

Housing

* 8. Which best describes your current living situation?

* 9. How much is your monthly rent or mortgage payment?

* 10. What is the amount of rent or mortgage that you can adequately afford so there is money available for food, utilities, transportation, etc.?

* 11. If you do not have stable housing, what factors contributed to you losing or not securing stable housing? Check all that apply.

* 12. How would you rate the availability of affordable housing in Douglas County?

* 13. Have you ever experienced housing discrimination based on any of the following? Check all that apply.

* 14. Please rank (number 1, 2 and 3) the top three issues that you feel are most important in providing safe and secure housing for low- and moderate-income residents of Douglas County:

* 15. What one type of housing do you feel is most important for people with low- and moderate-incomes in Douglas County?

Employment

* 16. Which best describes your current employment situation? Check all that apply.

* 17. What education level have you completed?

* 18. If you are unemployed, how long have you been unemployed?

* 19. How many jobs do you currently have?

* 20. How many miles do you commute or ride round-trip for all jobs per day?

* 21. Is your primary job located in Douglas County?

* 22. If you answered yes to question 21, would you prefer to work in Douglas County?

Transportation

* 23. On a regular basis, what form of transportation do you use most?

* 24. Which of the following are you unable to access due to lack of transportation? Check all that apply.

* 25. Do you feel like Douglas County has adequate types of transportation opportunities to meet your needs?

Services for the Disabled

* 26. Is accessing reliable transportation a barrier to any of the following? Check all that apply.

* 27. What barriers have you experienced in accessing adequate housing that meets your needs?

* 28. Please rank (number 1, 2 and 3) the top three improvements most needed in Douglas County for persons with disabilities?

General Information

* 29. Where do you live?

* 30. What is your gender?

* 31. What is your race? Check all that apply.

* 32. Other than English, what language are you best able to communicate in?

* 33. What age group do you fit into?

* 34. How many adults age 18 and older currently live in the household? Please include yourself.

* 35. How many children under the age of 18 currently live in the household?

* 36. Which best describes your current housing situation?

* 37. What is your annual household income?

* 38. Do you receive any of the following? Check all that apply.

* 39. Do you have health insurance?

* 40. If you have Medicaid or Medicare, do you have a provider that accepts it?

* 41. If you have health insurance, are you able to afford costs associated with your healthcare? Examples – co-pays, prescriptions, etc.

Additional Participation or Contact (Optional)

* 42. This section is optional. If you wish to be contacted about any of the check boxes below, please provide your contact information.

* 43. Name:

* 44. Address, City, State and Zip Code

* 45. Phone:

* 46. Email:

* 47. How would you prefer to be contacted? Please check only one.

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