Welcome to CPCA's Community Needs Assessment Survey

​The information gathered will assist us in identifying the top needs within our community and providing programs and services that fit those needs.

Please answer every question. All responses are anonymous and your feedback is important!

Thank you for participating in our survey!


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* 1. Which describes you and your relationship to CPCA? (Select only one)

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* 2. Are you:

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* 3. City or Town where you live?

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* 4. County of Residence?

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* 5. Your Age Group:

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* 6. How many children do you have in the home?

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* 7. Are you a single parent?

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* 8. Are you a Veteran?

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* 9. What is your Household Size?

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* 10. What is your level of income? (Select only one)

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* 11. What is your current housing status? (select only one)

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* 12. In your opinion, what is the primary cause of unemployment in our community? (Select only one)

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* 13. In your opinion, what is the primary cause of the transportation barriers in your community? (Select only one)

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* 14. In your opinion, what are the biggest issues facing youth (ages 0-24) in your community? (Check up to three)

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* 15. In your opinion, what are the biggest issues facing the adults (ages 25 and older) in your community? (Check up to three)

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* 16. For each community resource, please identify which 'level of need' you feel is appropriate.

  Most Needed Somewhat Needed Not Needed Don't Know
Adult Education/GED Classes
Affordable Housing
Affordable Legal Services
Assistance for Electric/Gas Bills
Assistance for Sewer/Water Bills
Caregiver Supports of Senior Citizens
Caregiver Supports of Children with Disabilities
Childcare
Financial Education (Credit Counseling)
Food Assistance
Free Income Tax Prep Services
Financial Aid for Certification/Degree
First Time Home Buyer Assistance
Health Insurance Coverage
Healthy Relationship Classes/Programs
Help Seeking Reliable Transportation
Help With Keeping a Budget
Help Seeking Employment
Home Repairs
Home Services/Shelters
Mental Health Services
Mortgage/Rental Assistance
Nutrition Education
Parenting Skills Education
Removal or Repair of Blighted Properties
Weatherization Services

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* 17. Would you know where to get help if you or someone else was experiencing the following?

  Yes No
Bad Credit
Disability  and Not Being Able to Work
Domestic Violence
Homelessness
Home Repairs
Income Tax Preparation
Lack of Childcare
Lack of Food
Obtaining Diploma/GED
Help Paying Gas/Electric Bills
Help Paying Sewer/Water Bills
Parenting Stress
Poor Nutrition/Lifestyle
Unemployment

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* 18. Do you have a bank account (i.e. checking or savings)?

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* 19. Do you have health insurance coverage?

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* 20. Do you have dental insurance coverage?

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* 21. Are you in need of an eye exam or glasses but cannot afford them?

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* 22. Do you have a computer at home?

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* 23. If No, do you have access to a computer? (i.e. relative/friends house; library; school)

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* 24. Do you have an internet connection at your home?

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* 25. Please provide any additional community needs and/or concerns.

0 of 25 answered
 

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