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Community Needs Assessment 2025
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1.
Zip Code?
(Required.)
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2.
Household Size
(Required.)
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3.
How many children live in the home? (under 18)
(Required.)
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4.
How many senior citizens live in the home? (60+)
(Required.)
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5.
Age of Person Taking Survey
(Required.)
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6.
Highest Education Completed
(Required.)
Less than High School
High School Graduate
GED
Some College
Diploma or Certificate from trade school
Associate's degree
Bachelor's Degree
Master's Degree or higher
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7.
Current employment status?
(Required.)
Employed full or part time
Retired
Disabled/poor health
Unemployed
Stay at home parent
Student
Other (please specify)
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8.
In the last 6 months, has your income increased, decreased or stayed the same?
(Required.)
Increased
Decreased
Stayed the same
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9.
How frequently do you worry about not having enough food to eat?
(Required.)
Daily
More than once a week
Weekly
More than once a month
Monthly
Hardly ever
Never
Other (please specify)
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10.
What are your primary needs at this time?
(Required.)
Food
Clothing
Housing
Employment
Healthcare
Other (please specify)
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11.
Why did you choose to receive services from SSCH?
(Required.)
Location
Staff
Programs offered
Other (please specify)
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12.
Are you satisfied with SSCH services?
(Required.)
Strongly Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
13.
Enter for a chance to win a $25.00 Kroger gift card!
Email Address
Phone Number
Current Progress,
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