1.NCCF recognizes that there are many pressing needs in the 20 communities that the Foundation serves. What do you feel are the FIVE most critical needs in the town where you live and/or work? Please check only five.(Required.)

Animal care (adoption and protection)

Civic improvement (beautification, social and cultural events)

Economic development (tourism, business support)

Financial support for postsecondary students, technical training

Job preparedness (training and re-training)

Conservation (land preservation, public education)

Healthcare (accessibility, public education, services, technology)

Historic preservation

Housing (affordability and accessibility)

Mental health (treatment, support services, education)

Childcare and after school programs

Food insecurity

Recreation (parks, outdoor events, playgrounds)

School readiness

Crime prevention and law enforcement

Care for the terminally ill or homebound (Hospice, Meals on Wheels, Chore)

Substance abuse (treatment, prevention, education)

The arts (theater, dance, visual, choral)

Transportation services (public, seniors, disabled)

Emergency housing

Employment and housing for persons with disabilities

Emergency response services (fire, ambulance, EMT)

Civic engagement (access to voting, voter registration)

Employment (job availability, living wages)

Other (Please specify.)

2.If you had to prioritize NCCF funding, please select your top three choices. Please check only three.(Required.)

Arts organizations - theater, dance, visual, choral

Emergency response services - fire and ambulance

Environmental, conservation initiatives

Historical societies

Hospitals and healthcare institutions

Humanitarian organizations (not local such as ASPCA, Make a Wish, etc.)

Libraries

Mental and behavioral health organizations

Park or public recreational facilities

Community advocacy groups

Religious or spiritual organizations

Local/community services (in your town or city)

Services for persons with disabilities

Public education programs

Private education programs

Family, child and youth agencies

Centers that serve senior citizens

Social services

Animal rescue and pet care organizations

Other (Please specify.)

3.NCCF supports programs that serve different groups. Which THREE recipient groups are the most important to you for funding opportunities? Please check only three.(Required.)

Artists (art, music, dance, voice)

At-risk children and teens

Postsecondary students

Behavioral health patients

Frail or homebound elderly

LGBTQ/Trans

Victims of sexual or domestic abuse

Substance abusers in treatment

Persons experiencing homelessness

Immigrants or non-English speaking

Animals (pets, farm animals, wildlife)

Persons with a disability

Community advocacy groups

Young children

Adolescents

Senior citizens, who are independent and mobile

Underemployed or unemployed

Women and girls

Other (Please specify.)

4.Is your primary residence (voter, car registration, etc.) in Connecticut?

Yes

No ( If no, please skip to Question 6.)

5.If your primary home is in one of the following NCCF towns, please indicate which one. Please skip to Question 7.)

Barkhamsted

Bethlehem

Canaan/Falls Village

Colebrook

Cornwall

Goshen

Hartland

Harwinton

Kent

Litchfield

Morris

New Hartford

Norfolk

North Canaan

Salisbury/ Lakeville

Sharon

Torrington

Warren

Washington

Winsted/ Winchester

I live in another town, not listed.

6.If your secondary (seasonal) home is in one of the following NCCF towns, please indicate which one.

Barkhamsted

Bethlehem

Canaan/Falls Village

Colebrook

Cornwall

Goshen

Hartland

Harwinton

Kent

Litchfield

Morris

New Hartford

Norfolk

North Canaan

Salisbury/ Lakeville

Sharon

Torrington

Warren

Washington

Winsted/ Winchester

7.If you work (either remotely or physically) in one of the following NCCF towns, please check which one. If regional, please check that response.

Regional (multi town provider)

Barkhamsted

Bethlehem

Canaan/Falls Village

Colebrook

Cornwall

Goshen

Hartland

Harwinton

Kent

Litchfield

Morris

New Hartford

Norfolk

North Canaan

Salisbury/ Lakeville

Sharon

Torrington

Warren

Washington

Winsted/ Winchester

I work in another town, not listed.

8.Please indicate your age category.

20-24

25-39

40-54

55-64

65-79

80+

9.In your household, are there any children under the age of 19?

Yes

No

10.Please indicate your housing status.

Homeowner

Renter