Shawnee County Kansas COVID-19 Community Response Survey Question Title * 1. Zip Code Question Title * 2. Ages In Your Household (select all that apply): 0-10 11-17 18-25 26-45 46-59 60+ Question Title * 3. How do you feel that COVID-19 has affected families in your neighborhood (select all that apply): Financially? Physically? Emotionally? Question Title * 4. Due to COVID-19, do you think that there is an increased need for assistance in your neighborhood with (select all that apply): Housing/rental or mortgage? Mental health? Drug and alcohol services? Childcare programs/services? Senior adult care programs/services? Question Title * 5. If Kansas adopted a $15 minimum wage, would it help your family (select the one that applies): A little? A lot? Not at all? Question Title * 6. Enter your name, address, and email address below for a chance to win a $ 50 gift card Name Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Question Title * 7. Do you have additional comments or suggestions? Add comments below or contact City of Topeka—Division of Community–620 SE Madison Ave, 66607, 785-368-3711, www.topeka.org Done