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Resident Opportunities and Self-Sufficiency Survey

1.Please provide your name(Required.)
2.Enter your phone number(Required.)
3.Enter your email address(Required.)
4.Where do you reside?(Required.)
5.Including yourself, select the box below for all the ages who reside in
your household (Select all that apply):(Required.)
6.What is your gender?(Required.)
7.Are you currently employed?(Required.)
8.Which is the following methods is best for GHA to contact you? (Select all that apply)(Required.)
9.Do you have connection issues or problems with your internet access in the community/apartment where you reside?(Required.)
10.Do you agree or disagree with the following statement: My family has access to the technology needed to access the internet effectively.(Required.)
11.What type of programs and services would you or members of your household most likely participate in? (Select all that apply):(Required.)
12.What are the best days to offer programs? (Check at least two boxes)(Required.)
13.What are the primary health care needs of your household? (check all that apply)(Required.)
14.What are the things that make it difficult for you or other adults in your household to find and/or keep work? (check all that apply)(Required.)