Legal Services of the Hudson Valley provides free legal services to Westchester, Putnam, Rockland, Orange, Sullivan, Dutchess and Ulster Counties. We rely on feedback from people like you to guide our work.

         Please help us by completing this survey. We greatly appreciate your time.

Part A:  Information About You

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* 1. How old are you?

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* 2. What County do you live in?

Part B:  Problems affecting your Community

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* 3. Please check three categories of legal problems that are most affecting you or members of your community.

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* 4. For each of the three categories you checked in the question above, please choose three specific issues that you believe most need our attention (check the box next to each issue).

Note:  Please only enter responses for the three categories you selected above.

Public Benefits

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* 5. Housing (eviction, bad conditions, foreclosure)

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* 6. Family (custody, domestic, violence, divorce, guardianships)

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* 7. Consumer (debt, garnishment, bankruptcy, collections

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* 8. Employment (discharge, discrimination, unemployment insurance)

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* 9. Education (special education services, learning disabilities, suspension

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* 10. Health (Medicaid, Medicare, Nursing Home Care, Mental Health, Long-Term Managed Care

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* 11. Immigration (permanent residency, green card, visa deportation)

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* 12. Individual Rights (court-ordered name change and correcting a gender marker)

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* 13. Advanced Care Planning (wills, health care proxy, etc.)

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* 14. Part C:  What legal issues have you had in the last year?  Please check all that apply.

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* 15. Part D:  If you need legal information, what is the best way to get it?  Please check all that apply.

THANK YOU FOR YOUR FEEDBACK
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