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* 1. Why do you feel that employment is a problem in your area?

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* 2. Why do you feel that education is a problem in your area?

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* 3. Why do you feel that housing is a problem in your area?

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* 4. Nutrition is a problem in this area because?

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* 5. Why is the lack of income a problem in your area?

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* 6. Why is transportation a problem in this area?

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* 7. Why is health care a problem in this area?

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* 8. Is anyone in your home disabled?

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* 9. What COUNTY do you live in?

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* 10. What is your gender?

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* 11. What is your age?

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* 12. Which race best describes you? (Please choose only one.)

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* 13. What is your ethnicity? 

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* 14. Which of the following categories best describes your employment status?

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* 15. What is the highest level of education that you have completed?

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* 16. What is the total combined income for everyone in your household?

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* 17. What programs and services do you think are needed in the community both presently and in the future?

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* 18. Do you feel that the residents in your community are aware of the programs and services that take place in the community, and if not, do you have any ideas on how to make them aware?

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