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* 1. How many people live in your household?

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* 2. Of those living in your household, how many are in each age category below?

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* 3. What County do you live in?

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* 4. What Steuben County ZIP code do you live in?

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* 5. OR - What Yates County ZIP Code do you live in?

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* 6. Rank in order  of 1 (highest) through 5, the top five needs that you and/or your neighbors experienced in the last month?

  1 2 3 4 5
Access to enough food
Adult Education/ literacy
Child care
Dental care
Domestic violence assistance
Family counseling
Financial assistance
Health care
Heating/ utility assistance
Job skills training
Legal services
Mental health services
Parenting education
Preschool programs
Safe, affordable housing
Safety/ crime prevention
Senior citizen services
Substance abuse services
Summer recreation
Transportation
Veteran services
Youth programs
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