Gateway Community Action Partnership Community Member Needs Survey

To better serve individuals and families in our area, Gateway Community Action Partnership is surveying members of our community to get honest and meaningful feedback on what we are doing well, what we could do better, what areas of need we are addressing and what areas of unmet need exist. Please take a few minutes to complete this survey and provide your valued insights so that we might better provide for those most in need and to improve their quality of life and promote self-sufficiency. Thank you for your participation and continued support.

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* 1. Are you receiving services or have you received services from Gateway Community Action Partnership or its programs in the past 12 months?

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* 2. Were you satisfied with the services received? 

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* 3. How did you hear about Gateway Community Action Partnership? Check all that apply: 

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* 4. Where do you live? Please enter your County and Zip Code below:

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* 5. How many people live in your household?

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* 6. What is your race?

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* 7. What is your age?

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* 8. What is your sex?

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

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

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

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

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* 13. If you needed services but didn't get them, what was the reason?

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

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* 15. What is your PRIMARY mode of transportation? Check one that applies:

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* 16. In the past 12 months, has lack of transportation been a problem for your household?

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

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* 18. In the past 12 months, have you or has anyone in your household experienced any of the following financial situations? Check all that apply:

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* 19. In the last 12 months, what was your estimated gross annual household income? (Please include all sources of income)

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* 20. What is your housing status?

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* 21. Have you experienced the following problems related to housing in the past 12 months? Check all that apply:

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* 22. If you rent your place, check the utilities that are included in your rent:

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* 23. If you do not own a home, what prevents you from buying one?

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* 24. In the past 12 months, have you or has anyone in your household skipped or cut the size of a meal because there was not enough food?

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* 25. Are you able to afford enough formula for your infant?

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* 26. In the past 12 months, have you or has anyone in your household used any of the following food assistance services? Check all that apply:

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* 27. Do you feel safe in your neighborhood?

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* 28. Are you a grandparent or other relative raising children other than your own?

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* 29. If yes, please indicate the PRIMARY reason for care. Check one that applies: 

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* 30. Is there someone in your household with a disability? (Adult or child under the age of 18)

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* 31. Please add anything you would like Gateway Community Action Partnership to know:

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* 32. What is the one service that has helped you or someone in your household the most within the past 12 months?

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