CAPIC COMMUNITY NEEDS SURVEY

1.What do you think are the TOP needs impacting people in your community? Check ALL That Apply

After school / summer programs for children and youth

Training or education to get a job or better job

Child care

Domestic violence services

Jobs

Safer neighborhood

English classes

Transportation

Elder services

Ability to budget

Affordable housing

Legal assistance

Ability to pay heating or utility bills

Need for clothing

Access to food

Financial emergencies

Health insurance

Immigration issues

Mental health services

Discrimination issues

Drug and alcohol services

Access to technology / internet

2.Compared to 3 years ago, are you and your family now better off, worse off, or about the same?

Better

About the Same

Worse

3.Are you able to pay your bills on time each month?

4.Do you currently have at least $500 set aside for emergencies?

6.Where do you live?

Chelsea

Revere

Winthrop

7.What is your age?

8.What is your gender, as you define yourself?

9.Are you Hispanic/Latino?

10.What is your race?

11.What is your household’s monthly income before taxes?

Include: Wages, TANF, Social Security, Disability Benefits, etc.

Do NOT include: Food Stamps (SNAP), WIC, MassHealth, Other Public Health Insurance, Fuel Assistance, etc.

12.How many people Under 18 are in your household including yourself?

13.How many people 18 or Older are in your household including yourself?

14.Are you a CAPIC Client?

Yes

No

We Thank you for completing this survey!

We appreciate your thoughts & opinions on the needs in the local area. Your input will help CAPIC work to address these needs and work to improve the quality of life for all residents. *Survey is also available in Spanish.

www.capicinc.org · 100 Everett Avenue, Unit 14, Chelsea, MA 02150

617-884-6130