Instructions:  Indicate your agreement with the following statements by providing the answer that best represents your opinion

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* 1. About My Community

  Strongly Agree Agree Disagree Strongly Disagree
I like living in this community.
I encourage people to move to my community.
My community welcomes change.
My community illustrates community pride.
My community needs to make changes.
The appearance of property in my community encourages others to relocate here.
People in my community take care of each other

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* 2. About Local Leadership

  Strongly Agree Agree Disagree Strongly Disagree
My community does a good job of promoting themselves.
Community leaders and organizers share information with residents.
I understand how decisions in my community are made.
People in my community work together.
Community leaders are accessible to discuss issues and ideas.

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* 3. About My Involvement

  Strongly Agree Agree Disagree Strongly Disagree
My voice matters with regard to what happens in my community.
I am involved in my community.
I attend community events.
I need to be involved to help my community become more successful.

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* 4. About Community Systems

  Strongly Agree Agree Disagree Strongly Disagree
Resources are available in my community for people to start new businesses.
Buying a home in my community is a good idea.
My community has adequate child care services.
My community supports entrepreneurship.
There is a stable community infrastructure to draw new families to this community.
My community has a variety of shopping to meet my needs.
There are other health resources I would like to have available in my community.

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* 5. About Community Growth

  Strongly Agree Agree Disagree Strongly Disagree
My community will thrive in the next five years.
There are opportunities for young adults (15-30 years old) to be engaged in my community.
I shop locally as much as possible.
New housing opportunities are increasing in my community.
I have a positive outlook about my community's future.
Business is growing in my community.
New businesses are moving into my community.

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* 6. How would you rate each of the following services in Kimball?

  Good Fair Poor
City Government
Law Enforcement
City Utilities:  water and sewer
Street repair, cleaning, and plowing
Parks, playgrounds, and recreational activities
Tourism
Other:_____________________________________

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* 7. I am currently involved in the following organizations/activities in my community:

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* 8. Where do you live and work? (Select all that apply)

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* 9. Are you male or female?

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* 10. What is your age?

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* 11. If you live in the Kimball Zip Code, do you have children?

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* 12. If you answered yes to Question 11, please list how many children you have in each of the age ranges.

  # of Children
Ages 0-4
Ages 5-8
Ages 9-12
Ages 13-15
Ages 16-18

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* 13. Name ONE improvement that would make Kimball the best community possible.

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* 14. Is there anything else you'd like to share about living in the Kimball Area?

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* 15. Contact Information (optional)

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