Thank you for taking this survey...Your participation is very helpful! 
 
The following questions will be used solely for statistical analysis.  Your responses will remain strictly confidential and will not be shared.
 
By completing this survey, you will help towards research of understanding families' resources and needs. You will be asked to answer survey questions that include education, employment, income, housing, nutrition and healthcare. This will take approximately 15 - 20 minutes of your time.

The benefit of this research is that you will be helping the organizations in your community to better understand our community needs, the resources available and the services that are still needed. This information will help us to work together to address services that are needed the most. There are no risks to you for participating in this study, and no penalty for not participating.

To show our appreciation for participating in this effort, upon completion of this. survey you will be given a chance to register in a drawing for a $100 Gift Card.  We will be giving away 3 gift cards, individually, to the winners of the random drawing.  Once you click submit, you will be automatically directed to the registration page.  

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* 1. Today's Date.

Date

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* 2. What is your gender?

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* 3. What is your age?

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* 4. Which race/ethnicity best describes you? (Please choose only one.)

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

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* 6. Which answer choice below best describes your marital status?

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Please reference this map to answer the following questions.

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* 7. In which school district(s) do you live or stay? Check all that apply.

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* 8. In which school district(s) do you work?  Check all that apply.

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* 9. Do you have a telephone?

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* 10. Do you have access to the Internet?

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* 11. Where do you usually use the Internet?  (Check all that apply.)

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* 12. What device(s) do you use to access the Internet, usually?  (Check all that apply.)

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* 13. How many people live in your home or wherever you stay?

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* 14. What language do you speak at home?  (Check all that apply.)

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* 15. Do you, or someone in your household have special needs?

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* 16. Do you have minor children? (Under the age of 18.)

If you answered "No" to the question above, skip to question 22.

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* 17. Are you the primary caretaker of your kids?

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* 18. If you have children, which of the following answer choices best describes your current family situation?

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* 19. Who provides your childcare, or dependent's care? (Check all that apply.)

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* 20. Do you need more dependable or additional childcare help?

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* 21. If you answered yes to the last question, what type of childcare help do you need? (Check all that apply.)

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* 22. Are you caring for adult children or adult dependents including seniors?

If you answered "No" to the question above, skip to question 24.

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* 23. Who provides care for the adult children or adult dependents? (Check all that apply.)

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* 24. OVERALL NEEDS - Which topics below are the areas where you have the most needs?  Rank them in order from 1 (most needed) to 6 (less needed).

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* 25. Do you have any of the following housing related needs?  (Check all that apply.)

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* 26. What is your total estimated annual household income range?  (Pick the answer choice that most closely matches your estimate.)

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* 27. What are your household sources of income?  (Check all that apply.)

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* 28. Which of the following assistance programs do you or members of your household receive to help pay bills?  (Check all that apply.)

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* 29. Which of the following monthly household bills do you have?  (Check all that apply.)

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* 30. Do you have any of these financial needs or problems?  (Check all that apply.)

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* 31. Which of the following best describes your education level? (Select all that apply.)

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* 32. Do you have any of the following educational needs? (Select all that apply.)

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* 33. Do you have any of the following employment needs? (Select all that apply.)

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* 34. Are you able to work?

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* 35. Which of the following best describes your current employment status?

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* 36. If you are unemployed, are you currently looking for work?

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* 37. If you are unemployed, which answer choice below best describes why?  (Check all that apply.)

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* 38. If you were able to have a sponsorship that paid for some or all of the following work-related training, which would you have the most interest in?  (Check all that apply.)

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* 39. Where do you usually get your food?  (Check all that apply.)

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* 40. Do you have any of the following food related needs?  (Check all that apply.)

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* 41. Do you have health insurance or healthcare coverage?

If you answered "No" to the question above, skip to question 43.

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* 42. If you answered yes to the last question is your health insurance or coverage policy for you individually or for you and your family?

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* 43. If you have health insurance or health coverage where do you get it from? (Check all that apply.)

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* 44. Are there people in your household who are uninsured?

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* 45. Do you have any of the following healthcare related needs?  (Check all that apply.)

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