Jefferson County Committee for Economic Opportunity
2021 Client Survey

Your opinion is important to us.
PLEASE TAKE A FEW MINUTES TO COMPLETE THIS SURVEY.

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* 1. How long have you lived in Jefferson County?

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* 2. What is your zip code?

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* 3. Of the list below, which SIX issues concern you the most in your neighborhood or community?

Job Training and employment services

Employment opportunities

Adult education

Schools and education for children

Language barriers (non-English speaking)

Lack of affordable housing

Lack of shelter for homeless families

Lack of food for low-income

Lack of food for elderly

Affordable healthcare

Available mental healthcare

Service for disabled children

Service for disabled adults/elderly

Lack of transportation

Cost of utilities (gas, electricity, water)

Cost of rent/house payment

Money management, budgeting

Use of title or payday loans

Teen pregnancy

Lack of quality childcare

Cost of childcare

Child abuse and neglect

Crime, violence, drug abuse

Domestic Violence

Other (please specify)

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* 4. Of the list below, which SIX are most important issues for your family?

Job training

Employment

Educational services for children (tutoring, testing, etc.)

Education for adults (GED, etc.)

Language skills (learn English)

Money management, budgeting

Use of title or payday loans

Affordable housing

Housing maintenance and repair

Food

Transportation costs

Personal safety, domestic violence

Childcare

After-school care

Summer care for school-age children

Service for disabled child

In-home care/service for disabled adult/elderly

Substance abuse

Affordable health care, health insurance

Getting health/dental care

Paying for prescribed drugs

Other (please specify)

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* 5. What is your age?

18-25

26-35

36-45

46-55

56-65

66+

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* 6. What is your gender?

Female

Male

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* 7. What is your ethnic group?

Caucasian/White

African-American/Black

Hispanic/Latino

American Indian

Asian

Multi-racial

Other (please specify)

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* 8. What is the highest level of education you achieved? Check one.

Did not graduate from high school

High School Graduate/GED

Attended 1-2 years college or technical school

Associate's degree or two-year certificate

Technical degree or certificate

Attended 3-4 years college or technical school

Bachelor's degree

Master's degree or higher

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* 9. Are you the head of your household?

Yes

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* 10. Do you own or rent you home?

Own

Rent

Other (please specify)

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* 11. What is your employment status? Check one.

Full-time employed

Part-time employed

Self-employed

Unemployed-student

Unemployed-SSI/Disability

Unemployed by choice

Unemployed-cannot find job

Retired

Volunteer

Other (please specify)

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* 12. Do you have health insurance? Check one.

Yes, but only for myself

Yes, but only for my children

Yes, for my entire family

No, I do not have health insurance

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* 13. How many adults, counting yourself, live in your household?

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* 14. How many children (ages birth-17) live in your household?

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* 15. Is anyone in your household disabled?

Yes

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* 16. If yes, how old are they?

0-17

18-25

26-35

36-45

46-55

56-65

65+

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* 17. What is your annual income?

Less than $15,000

$15,000-$25,000

$25,001-$40,000

$40,001-$60,000

$60,001-$75,000

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* 18. We welcome your additional comments...

You're done! Thank you for completing the JCCEO 2021 Client Survey!