Completing this confidential survey will give us a better understanding of the different needs and challenges in our service area and help us to work with others to find solutions. We will have the results and the full Needs Assessment Report posted to our website in October.  

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* 1. Where do you live?

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* 2. What is your age?

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* 3. Not including yourself, how many people in your household are in the following age categories?

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* 4. Gender

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* 5. What is your employment status?

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* 6. Which of the following best represents your total household income before taxes?

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* 7. Check any of the following that are unmet needs for you or your family.

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* 8. Check any of the following services you or your family are in need of.

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* 9. Check any of the following that are unmet health needs for you or family members.

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* 10. Is lack of transportation a reason for any of the above needs not being met?

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* 11. What do you think prevents people from having the best health possible in your community? (check the top three)

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* 12. What do you think are the challenges around transportation in your community (check the top three)

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* 13. What is your current housing situation?

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* 14. What do you think are the biggest housing problems for individuals in your community (check the top three)

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* 15. What do you think are the challenges individuals face when they are in need of help from various social services? (check the top three)

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* 16. What do you see as obstacles to employment for individuals in your community? (check the top three)

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* 17. What is your highest level of education?

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* 18. What do you think prevents individuals from going to college or getting additional training in your community? (check the top three)

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* 19. Do you currently utilize any of the following Penquis services?

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* 20. What is your community doing well for its citizens?

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* 21. What do you think would help people move out of poverty?

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