1.Do you live in DuPage County?

Yes

No

2.What is your household's zip code?

3.What is your gender?

Female

Male

Non-binary/third gender

Prefer not to say

Prefer to self-describe

4.What is your age range?

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65+ years old

5.EMPLOYMENT: What do you or a family member need help with (select all that apply)...

Finding a full-time job

Applying for jobs

Writing a resume

Learning how to interview for a job

Training or education for the job that I want

Getting appropriate clothing for my job

Getting equipment (e.g.) tools for my job

I do not have any employment needs right now

Other (please specify)

6.EDUCATION: What do you or a family member need help with (select all that apply)...

Getting a high school diploma or GED/HSED

Getting a two-year college degree

Getting a four-year college degree

Choosing a career

Choosing a technical school program

Learning how to use a computer

Improving communication or language skills

Learning English (as a second language)

Help paying for my education

Completing college aid forms (including FAFSA forms)

I do not have any education needs right now

Other (please specify)

7.FINANCIAL AND LEGAL ISSUES: What do you or a family member need help with (select all that apply)...

Budgeting and managing money

Opening a checking or savings account

Filling out tax forms

Understanding credit scores

Problems with a credit card or loan company

Problems with utility or telephone company

Problems with payday loans

Foreclosure/bankruptcy/repossession problems

Divorce problems

Child custody problems

Child support problems

Getting protection in domestic violence situations

Legal help with deportation or immigration issues

Getting legal help when denied services

I do not have any financial/legal needs right now

Other (please specify)

8.HOUSING: What do you or a family member need help with (select all that apply)...

Finding affordable housing

Help with a down payment/closing costs to buy a home

Qualifying for a loan to buy a home

Home ownership education

Renter/tenant rights and responsibilities education

Learning basic home repair/property maintenance skills

Getting help with rent/payments

Getting help with rent deposits

Making my home more energy efficient

Changes to my home for a person with disabilities

Getting emergency shelter

Addressing housing discrimination

I do not have any housing needs right now

Other (please specify)

9.FOOD AND NUTRITION: What do you or a family member need help with (select all that apply)...

Getting food from food pantries

Learning how to shop and cook for healthy eating

Getting more food for my money

Getting meals delivered to my home

Learning how to model healthy eating for my children

Getting nutritious foods during pregnancy

Obtaining breastfeeding education and assistance

I do not have any food/nutrition needs right now

Other (please specify)

10.BASIC NEEDS: What do you or a family member need help with (select all that apply)...

Basic furniture, appliances, or house wares

Personal care items like soap, diapers, toilet paper, etc.

Clothing and shoes

Yard work or snow removal

House work or laundry

Managing medications

Having a reliable phone

Getting access to the Internet

Paying utility bills (heating, electric, and/or water)

I do not have any basic needs right now

Other (please specify)

11.CHILD CARE AND CHILD DEVELOPMENT: What do you or your family need help with (select all that apply)...

Finding child care in a convenient location

Finding quality licensed child care

Finding affordable child care

Finding child care for babies

Finding child care for toddlers

Finding child care for preschoolers

Finding evening or nighttime child care

Finding weekend child care

Finding a quality preschool

Finding a before/after school program

Preparing my preschool child for public school

Paying for child care

Paying for school supplies

Paying school fees

Paying for school or club activities

I do not have childcare needs right now

Other (please specify)

12.PARENTING AND FAMILY SUPPORT: What could you or your family use help with (select all that apply)...

Disciplining my child more effectively

Communicating with my teenage child

Addressing a child's bullying or violent behavior

Talking to my child about drugs

Talking to my child about sex, STDs, etc.

Helping my child cope with emotional issues

Learning how to set goals and plan for my family

Talking to my child's care provider or teachers

I do not have parenting needs right now

Other (please specify)

13.TRANSPORTATION: Which transportation needs could you or your family use help with (select all that apply)...

Getting to public transportation

Reliable transportation to and from work

Buying a dependable car

Paying for car repairs

Paying for car insurance

Paying car registration or license fees

Getting a driver's license

Getting to and from medical or dental appointments

Getting myself to and from school

Getting my children to and from child care

Getting my children to and from school

Getting my children to and from activities

Going shopping and doing errands

I do not have transportation needs right now

Other (please specify)

14.HEALTH: Which health needs could you or a family member use help with (select all that apply)...

Affordable health insurance

Affordable dental insurance

Finding health care

Finding dental care

Getting my health insurance questions answered

Paying for regular medical checkups

Paying for regular dental checkups

Paying for medicine and prescriptions

Paying for glasses, hearing aids, wheelchairs, etc.

Paying for long-term health care

Getting help with family planning or birth control

Getting good medical care before my baby is born

Getting regular check-ups, developmental screens, or physicals for my child

Vaccines for my children

Help with a drug or alcohol problem

Mental health treatment

Stress, depression, or anxiety

Physical, emotional, or sexual abuse

I do not have health needs right now

Other (please specify)

15.Are there needs that you or your family faced within the last 12 months that you were unable to get help with?

No

Yes (if YES, please list those problems or needs)

16.What is ONE thing you would like to see improved in your neighborhood?