Partner Survey Gateway Community Action Partnership Partner Survey Question Title * 1. What is the name of the organization you represent? Question Title * 2. What is the type of organization you represent? Check one that applies: Community-based organization Faith-based organization Private sector Public sector Educational institution Question Title * 3. What is your position and/or title? Question Title * 4. What is your organization’s relationship to Gateway Community Action Partnership? Check one that applies: Not affiliated or associated with Gateway Community Action Partnership Collaborative partner (referrals, etc.) Contract partner (formal legal agreement, MOU, etc.) Partnership (shared resources) Fellow human service agency Other (please specify) Question Title * 5. Please list three positive aspects of the county you are representing: County: 1. 2. 3. Question Title * 6. Please list three negative aspects of the county you are representing: County: 1. 2. 3. Question Title * 7. What are the top most pressing needs of the low-income population in the county you are representing? Check only three: Adult Education/Literacy Child Care Dental Care Domestic Violence Assistance ESL/ELL Family Counseling Financial Assistance Food Assistance Health Care Heating / Utility Assistance Job Skills / Employment Training Jobs / Employment Mental Health Services Parenting Education Safe, Affordable Housing Safety / Crime Prevention Senior Citizens Services Substance Abuse Assistance Summer Recreation Programs Transportation Veteran Services Youth Programs None of the above Other (please specify) Question Title * 8. In the previous question, you specified three pressing needs of the low-income population in the county you are representing. Please rank these most pressing needs from highest to lowest, with #1 being the highest need, by listing them below: 1. 2. 3. Question Title * 9. Which of the following services do not meet the demand in the county you are representing? Check only three: Adult Education / Literacy Child Care Dental Care Domestic Violence Assistance ESL/ELL Family Counseling Financial Assistance Food Assistance Health Care Heating / Utility Assistance Jobs / Employment Job Skills / Training Mental Health Services Parenting Education Safe, Affordable Housing Safety / Crime Prevention Senior Citizens Services Substance Abuse Assistance Summer Recreation Programs Transportation Veteran Services Youth Programs None of the above Other (please specify) Question Title * 10. In the previous question, you specified three services that do not meet the demand in the county you are representing. Please rank these services that do not meet the demand, with #1 representing the most prominent gap, by listing them below: 1. 2. 3. Question Title * 11. What are the most challenging community issues that low-income households in the county you are representing will face in the next three years? Check only three: Adult Education/ Literacy Child Care Dental Care Domestic Violence Assistance ESL/ELL Family Counseling Financial Assistance Food Assistance Health Care Heating / Utility Assistance Jobs / Employment Job Skills / Employment Training Mental Health Services Parenting Education Safe, Affordable Housing Safety / Crime Prevention Senior Citizens Services Substance Abuse Assistance Summer Recreation Programs Transportation Veteran Services Youth Programs None of the above Other (please specify) Question Title * 12. In the previous question, you specified three challenging community issues that low-income households will face in the next three years. Please rank these most challenging community issues, with #1 being the most challenging issue, by listing them below: 1. 2. 3. Question Title * 13. What can we do as community partners/collaborators to better address these issues in the future? Question Title * 14. Has your organization eliminated any service(s) in the last year? Yes No If yes, please specify what service(s): Question Title * 15. Are you aware of any impending funding cuts or funding changes that will impact your services? Yes No If yes, what funding cuts or changes? What will be the impact on services, if any? Question Title * 16. If you are aware of any program areas within your agency/organization that could benefit from a new partnership and/or enhanced collaboration with Gateway Community Action Partnership, please describe the potential opportunities that could be considered: Question Title * 17. Would you be interested in being contacted to discuss new partnership and/or enhanced collaboration further? Yes No If yes, please provide your contact information:Name:Organization name:Phone number:Email address: Done
