The Joslyn Center is beginning to plan for the future and we need your help.  These questions will help us better understand our members,  stakeholders, and your needs.  We would appreciate your honest and thoughtful answers and opinions, and can only improve our services with your input.   We will be reporting on the results of this survey and our planning process in order to help keep you fully informed.  Thank you for your time and attention. 

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* 1. What Community do you live in?

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* 2. What is your gender?

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* 3. What is your age range?

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* 4. What is your ethnicity?

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* 5. Marital Status

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* 6. Are you a member of the LGBTQ Community?

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* 7. Special Conditions

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* 8. Household Composition

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* 9. Including yourself, does your household have any individuals in each age group below? Please check each box that may apply.

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* 10. Are there children under the age of 18 living in your household?

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* 11. Are you a grandparent raising grandchildren?

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* 12. If you answered "yes" to question 11, how many children under age 18 are living in your household?

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* 13. What are the primary languages spoken in your home?

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* 14. Please check the income range that applies to your household.

  Family Size of 1 Family Size of 2 Family Size of 3
Income Range

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* 15. With Health in mind, please check each of the areas that you or someone you know has dealt with over the past 12 months.

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* 16. With Finances in mind, please check each of the areas that you or someone you know has experienced over the past 12 months.

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* 17. With housing in mind, please check each area you or someone you know has dealt with over the past 12 months.

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* 18. With individual rights in mind, please check each of the areas that you or someone you know has experienced in the past 12 months.

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* 19. Keeping your family or personal relationships in mind, please check the areas that you or someone you know has dealt with over the past 12 months.

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* 20. Keeping transportation in mind, please check the areas that you or someone you know has dealt with over the past 12 months.

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* 21. Do any of these additional issues apply to you or someone you know?

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* 22. In the last 12 months, the food that I bought just didn't last, and I didn't have money to get more.

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* 23. In the past 12 months, I couldn't afford to buy healthy foods such as (mark all that apply).

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* 24. In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money?

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* 25. In the months when money is tight, I sometimes have to choose between food and (please mark all that apply)

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* 26. Please tell us the programs and services you have participated in at The Joslyn Center. (Please check all that apply)

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* 27. How often do you participate in the programs, services or clubs of The Joslyn Center?

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* 28. The Joslyn Center is clean and inviting.

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* 29. I am treated well at The Joslyn Center.

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* 30. The paperwork and process at The Joslyn Center is easy to understand.

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* 31. The Joslyn Center has the necessary number of volunteers to assist me when I need help.

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* 32. What do you like best about your experience at the Joslyn Center?

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* 33. What do you like least about your experience at The Joslyn Center?

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* 34. How can we improve your experience at The Joslyn Center?

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* 35. What types of programs or services would you like to see at The Joslyn Center?

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* 36. Are you interested in volunteering at The Joslyn Center?

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* 37. Is there anything else you would like to tell us?

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