Community Survey

This survey is to be completed by all community members in Defiance, Fulton, Henry, Paulding, Van Wert and Williams counties. The purpose of this survey is to access the needs of the communities we serve, to ensure that our services are aligned with those needs, and to identify any gaps in services.

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* 1. What is your zip code?

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* 2. What is your age?

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* 3. What is your gender?

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* 4. What is your race?

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* 5. Are you Hispanic/Latino?

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* 6. What is your education level?

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* 7. What is your primary source of income?

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* 8. What is your household's yearly gross income?

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* 9. What is your household composition?

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* 10. How many people live in your household?

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* 11. What are the ages of each member in your household? (Please select all that apply)

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* 12. What is your current employment status?

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* 13. What is your primary language?

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* 14. My household has needs in the following areas (choose all that apply):

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* 15. What health and wellness services do you feel your community needs more of?

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* 16. How would you rate the availability of post secondary education or adult learning opportunities in your community?

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* 17. How would you rate the availability of skilled trade or technical resources in your community?

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* 18. What education or training opportunities do you feel your community needs more of?

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* 19. How comfortable are you with using the internet?

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* 20. Do you have access to the internet in your home?

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* 21. If you are unemployed or underemployed, it is because (choose the answer that best fits your situation):

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* 22. How would you rate the availability of resources and support for job seekers in your community?

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* 23. How often does your household experience food insecurity?

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* 24. Feeding my family is a problem because (choose all that apply):

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* 25. How would you rate the availability of childcare in your community?

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* 26. How would you rate the affordability of childcare in your community?

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* 27. Are you impacted by any of the following (check all that apply):

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* 28. What economic programming do you feel your community needs more of?

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* 29. What is your primary mode of transportation?

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* 30. Do you feel your community has adequate transportation services for those who cannot drive and/or do not have access to a personal vehicle?

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* 31. How would you describe your current housing situation?

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* 32. How would you rate the availability of housing in your community?

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* 33. How would you rate the affordability of housing in your community?

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* 34. What transportation or housing programming do you feel your community needs more of?

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* 35. Affordable housing in the county is a problem because (choose all that apply):

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* 36. How aware are you of community programs and services available to you?

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* 37. How would you rate the availability of services provided to the elderly in your community?

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* 38. How would you rate the availability of services to disabled people in your community?

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* 39. How would you rate the availability of services to children in your community?

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* 40. What are the most effective ways to engage the community in volunteering to help with events?

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* 41. How do you prefer to receive your information (check all that apply):

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* 42. What Services that NOCAC provides are you aware of? (Check all that apply)

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* 43. Have you or anyone in your household used a program provided by NOCAC?

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* 44. Please share any additional comments or concerns regarding the needs of our community.

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* 45. I have enough money saved in case of an emergency.

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* 46. In the past year, have you used (choose all that apply):

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* 47. I am need of the following home repairs (choose all that apply):

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* 48. What is your current housing situation?

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* 49. What county do you currently live in?

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* 50. Would you like NOCAC to contact you about any of our offered programs? (Choose all that apply):

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* 51. If you would like NOCAC to contact you, please fill out the following information.

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