Copy of Community Action Agency Survey 2024 Question Title * 1. Community Sector (Please select one) Low Income General Public Other (please specify) Question Title * 2. Gender Male Female Other (please specify) Question Title * 3. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305) Question Title * 4. How many people live in your household? 1-2 3-5 6-9 10+ Question Title * 5. Household Type (please select one) Two adults, no children Single Single Parent (mother) Single Parent (father) Other (please specify) Question Title * 6. Age 0-17 18-24 25-34 35-44 44-54 55-64 65+ Question Title * 7. Number of children under the age of 18? 1-2 3-4 5-6 7+ Question Title * 8. Number of seniors in your household age 60 or older? 1 2 3 4+ None of the above Question Title * 9. Ethnicity? Hispanic or Latino Non-Hispanic or Latino Question Title * 10. What is your race? (Please select all that apply.) American Indian or Alaskan Native Asian or Pacific Islander Black or African American Native Hawaiian White / Caucasian Multi-Race Prefer not to answer Other (please specify) Question Title * 11. What is the highest level of school that you have completed? K-8th Grade 9th-12th Grade (did not graduate) High school diploma or GED 12+ some college or post-secondary school 2-4 year college degree Question Title * 12. Annual household income range? Under $7,000 $7,001-$14,000 $14,001-$21,000 $20,001-$28,000 $28,001-$35,000 $35,001-$42,000 $42,001-$56,000 $56,001 or higher Question Title * 13. Is anyone in your household considered disabled (mentally or physically)? Yes No Question Title * 14. Is anyone in your home a veteran? Yes No Question Title * 15. What technology do you have in your home? Telephone Cellphone Computer, Laptop, Tablet None of the above Question Title * 16. Do you have reliable internet access at your home? Yes No Question Title * 17. What is your current living situation? Homeowner (house, condo, trailer, or other home) Rental (house, apartment, trailer or room) Someone else's house, apartment, trailer or room Homeless (shelter, street/outdoors, park) Transitional Housing Sober living house Other (please specify) Question Title * 18. EDUCATIONI need help with...... (check all that apply) Improving my ability to read Improving my ability to speak English Assisting someone in my family to get their GED or completing high school Learning a trade or vocation (for myself or someone in my household) Finding and/or enrolling in college (for myself or someone in my household) Finding activities for my child to help them get ready for school Developing parenting skills to support my child (such as effective discipline, setting limits, managing conflict) Finding more activities for my child outside of school hours (such as afterschool and summer programs) Securing childcare for my child when I am at school Helping my child with their classroom behavior Other (explain) Question Title * 19. EMPLOYMENTI need help with...... (check all that apply) Securing or obtaining new ID, birth certificate, or copy of social security card Finding a job (such as assessing online job board, job fairs) Finding a job that pays a living wage Securing a job (such as resume writing, interview coaching Getting the tools, equipment or clothing needed for my job Having reliable transportation to and from work Caring for my family and children while I am working (such as childcare) Developing the skills and values to be successful at work Finding employment that will hire someone with a criminal record Exploring career opportunities beyond the ones i know Receiving benefits/assistance and also maintaining or advancing in my job Other (explain) Question Title * 20. HOUSINGI need help with...... (check all that apply) Paying my rent or mortgage Paying for utilities Paying for security deposit Learning about and accessing homeownership assistance programs and services Learning about and accessing home repair services Learning how to reduce my household energy costs Finding and accessing more safe and affordable housing Learning about my rights as a renter and homeowner Other (other) Question Title * 21. HEALTHI need help with...... (check all that apply) Getting to and from healthcare services (such as medical appointments) Taking care of my family's dental health (such as finding a dentist, paying for services) Taking care of my family's hearing needs (such as getting hearing tests and hearing aids) Taking care of my family's vision needs (such as getting eye tests, eyeglasses) Getting health care and having a primary care provider Getting affordable health insurance Making sure my family's has healthy eating habits Learning more about available food resources (such as food pantries and food assistance programs) Learning about and accessing resources to care for an aging parent Accessing mental health care for myself or another adult (such as counseling, substance abuse treatment) Getting special needs services and resources for my child Paying for prescription medications Access to telehealth services Other (explain) Question Title * 22. INCOME AND ASSET BUILDINGI need help with...... (check all that apply) Making and managing a household budget Learning how I can use credit successfully and improve my credit score Learning how I can best save money Learning how I can best protect my money and prevent from being scammed Getting other legal advice and counsel Other (explain) Question Title * 23. Are there any other comments about community needs you would like to share? Done