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Tell Us About You & Your Household

Colusa, Glenn, Trinity Community Action Partnership (CGTCAP) is conducting a study of the needs of low-income people in its communities. Results from the study will be considered by the CGTCAP Board and the Glenn County Community Action Department for planning, developing, and delivering community activities, services, and initiatives. 

This survey will take approximately 15 minutes to complete.
Thank you for your time!

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* 1. In what county do you live?

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* 2. In what city/community do you live?

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* 3. To what stakeholder group do you belong? Select the answer that best describes your group.

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* 4. What is your age?

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* 5. How many children under age 18 live in your household?

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* 6. How many family members live in your household?

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* 7. Has anyone in your household ever served on active duty in the United States Armed Forces?

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* 8. What language is most often spoken in your home?

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* 9. What is your gender?

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* 10. Which of the following best describes your current marital status?

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* 11. What is your race/ ethnicity? (please check all that apply)

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* 12. What is your household’s yearly total combined income?

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* 13. With the following options, please estimate the percentage of household income that comes from each source:

  None 25% 50% 75% More than 75%
Full time job
Part time job
Own business
Retirement Benefits
Social Security Income
Rental Assistance
Public Assistance (CalFresh, etc)
Unemployment Insurance
Disability/ SSDI
Child Support
Alimony

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* 14. What is the highest level of education anyone in your household has completed?

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* 15. What type of housing best describes where you live now?

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* 16. With regard to your current place of residence, do you:

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* 17. How much are you currently paying for housing each month?

$100 $1,000 $2,000+
i We adjusted the number you entered based on the slider’s scale.

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* 18. If you are homeless, please describe your living situation:

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* 19. If you are homeless, or have had times of homelessness, what do you think are the reasons for your homelessness? (Please check all that apply.)

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* 20. Has your household filed for the Earned Income Tax Credit on the federal tax return?

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* 21. If you have not filed for the Earned Income Tax Credit, why not?

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