Thank you for taking the time to complete this survey. Northeast Oklahoma Community Action Agency regularly conducts a survey to determine what the needs are in your community so we will know where to best focus our efforts and funding. Your help in completing this survey is sincerely appreciated. Your feedback will help guide us to provide quality and needed services for families who are at-risk or living in poverty in the communities within the agency's service area. Please note that the survey has 2 sections (Questions 1-18 and Questions 19-22), please respond to both sections!

* Please list your City

* What is your zip code?

* What is your gender?

* What is your Ethnicity?

* What is your race?

* What is your highest level of education completed?

* What best describes your household?

* Number of persons in your household by age?

* What is the primary language spoken in the home?

* Is anyone in your household a veteran?

* Does anyone in your household receive disability benefits?

* If yes, please indicate # of each receiving disability benefits:

* What was your total household income last year?

* Mark the choice that best describes you:

* Are You:

* Do you have health insurance?

* What programs/services would you like to see continued in your Community?