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Goshen Help has contracted with ALIGN to conduct a Community Needs Assessment in Goshen County. It is important to answer all the questions; your answers are confidential. As a thank you for your input, you will be entered in a drawing for a $100 gift card. Survey will close October 12th. At the bottom of each page, click "next". 

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* 1. Please rate the following by putting an “x” in the appropriate column:

  Difficult for me most of the time Sometimes difficult for me Not difficult for me
Having a place to live
Being able to pay my rent or mortgage
Having enough food in the home
Being employed with a livable wage
Having reliable transportation that meets my needs
Having money to put gas in my car
Having adequate heat in the home
Accessing medical care
Accessing mental health services
Finding affordable childcare

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* 2. Which best describes the place where you are living currently? (Check only one)

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* 3. Please select whether you rent an apartment/home or own your home. If neither, select other and specify. 

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* 4. What is your monthly rent payment or monthly mortgage payment?

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* 5. Do you receive financial help with your rent or house payment from a government program or agency?

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* 6. Do any of these housing problems apply to you? (Check all that apply)

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* 7. What is your employment status?

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* 8. What are your barriers to employment? (Check all that apply)

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* 9. What town do you live in (or closet town if you live in the country)?

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* 10. Which best describes your household? (check only one)

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* 11. Including yourself, how many people live in your household? 

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* 12. How many persons in your household are 0 to 5 years old?

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* 13. How many persons in your household are 6-17 years old?

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* 14. Including yourself, how many persons in your household are 18-49 years old?

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* 15. Including yourself, how many persons in your household are 50-64 years old?

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* 16. Including yourself, how many persons in your household are 65+ years old?

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* 17. What is your annual income from all sources? (Including, but not limited to: employment, self-employment, Social Security, retirement, disability, worker’s compensation, unemployment, VA benefits, alimony).

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