Southwest Michigan Community Action Agency (SMCAA) would like your input to better serve you.

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* 1. What County do you reside in?

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* 2. Area of residence?

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* 3. What is your age?

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* 4. What is your race?

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* 5. What is your marital status?

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* 6. What is your gender?

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* 7. What is your highest level of education?

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* 8. Do you have a bank account?

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* 9. Have you ever received services from SMCAA before?

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* 10. What of the following needs does your family have? (Check all that apply.)

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* 11. Rank SMCAA services from MOST important to LEAST Important

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* 12. What is your household's annual income?

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* 13. What is your employment status?

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* 14. What are your employment barriers?

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* 15. What type of residence do you live in?

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* 16. What are your major housing concerns?

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* 17. Rate your satisfaction with the following.

  Great Good Fair Bad Awful
Affordable housing in your community
New housing development in your community
Mortgage and rent cost in your community
Condition of homes in your community

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* 18. Do you have any needs or concerns that SMCAA does NOT meet? (Check all that apply.)

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* 19. If you could choose only ONE service to receive from SMCAA, what would it be?

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* 20. Do you have any additional feedback?

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