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* 1. Are you a resident of Klamath or Lake county? If you are not a resident of Klamath or Lake county, please stop and return the survey. 

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* 2. Below are items that people need assistance with from time to time. Please make a check mark next to the items that you and your family have needed hep with recently.

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* 3. Are you able to meet your basic needs every month? 

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* 4. Do you know where to get assistance when you need it? 

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* 5. Do you have a checking account? 

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* 6. Do you have a savings account? 

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* 7. Have you every applied for a payday or quick loan? 

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* 8. Have you ever applied for a bank loan? 

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* 9. If yes, did you receive a bank loan? 

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* 10. Do you use email regularly? 

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* 11. Do you text regularly?

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* 12. Does each member of your household have medical coverage? 

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* 13. Which healthcare services are harder to get? (select all that apply)

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* 14. Which counseling services are the hardest to get? (Select all that apply)

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* 15. What barriers/challenges have you or your family experienced lately? For example, discrimination due to age, gender, race or disability.

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* 16. Are there accessible stores that sell fruit and vegetables?

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* 17. Are there enough opportunities for children and youth? 

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* 18. Is quality education available for children of all ages? 

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* 19. Is affordable and adequate childcare available?

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* 20. Are recreational opportunities available? 

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* 21. Are support groups available to meet your needs?

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* 22. Do you feel part of your community and welcome to attend public meetings/events? 

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* 23. Do you feel safe in your community?

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* 24. which housing services is most needed in your community? 

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* 25. Which transportation service is most needed in your community? 

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* 26. Please share what you like the least about living in your community. 

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* 27. How familiar are you with KLCAS' services for low-income individuals and families? 

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* 28. Which of these statements describes you best?

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* 29. Please check all of the services that you or your family have used in the past 12 months. 

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* 30. What zip code do you live in?

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* 31. What is your age group?

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* 32. What is your race? (Circle one) 

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* 33. What is your ethnicity? 

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* 34. What is your gender? 

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* 35. What is your family's annual income? (Select one) 

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* 36. Tell us about your household/living arrangements. (Select one) 

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* 37. How many dependents (0-17) live in your home?

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* 38. What is the highest level of education you have completed? (Select one) 

Thank you for your time and thoughtful responses to our survey.
We will be using your responses, views and recommendations as a foundation for the next three years of our programming. The needs assessment results will help the KLCAS Board of Directors create a strategic plan to initiate and support these programs and services. 
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