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* 1. Check one of these choices to let us know who completed the survey:

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* 2. Select the number that reflects your opinion on the need of each item:

  Don't Know Rarely Needed Very Needed
Transportation
Food
Childcare Assistance - Locating Finding Assistance
Resource Finding - Apply for SS, SSDI, WIC, TANF, etc.
Assistance with goals and self sufficiency
GED Classes
Computer Skills
Assistance to attend Vocational Training or College
Help finding a job/career
Help with job skills, training & job search
Financial Capability, Credit/Budget, Savings
Parenting Classes
Youth Activities
Senior Activities
Affordable Housing
Financial help with Rent or Mortgage
Health Insurance/Affordable Medical Care
Prescription Assistance

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* 3. The number of people in my household is:

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* 4. The MOST difficult expense in my life right now is: 

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* 5. The SECOND most difficult expense in my life right now is:

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* 6. Check all that apply: I have 

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* 7. The highest monthly income my household had in the past year was $______ in one month.

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* 8. Check all that apply: In the past 6 months, I've used: 

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* 9. Choose ONE: If I couldn't pay my rent, I would most likely use:

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* 10. Please rate your overall experience with GCCSA

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* 11. Please rate the ease of enrolling in GCCSA services:

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* 12. Please share the change in your circumstances after receiving services with GCCSA:

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* 13. Would you recommend our services to a friend:

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* 14. Before visiting GCCSA, which services did you most associate with our organization:

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* 15. How did you find out about GCCSA services:

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* 16. Please share any comments about your experience with GCCSA:

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