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2023 CAP Cayuga Seneca Community Needs Assessment Survey - Community Member
1.
How many people live in your household?
*
2.
Of those living in your household, how many are in each age category below?
(Required.)
0-5
6-13
14-24
25-55
56-65
66- or older?
*
3.
What County do you live in?
(Required.)
Seneca
Cayuga
Other (please specify)
4.
What Seneca County ZIP code do you live in?
14433
14456
14841
14847
14860
14489
14521
14532
14541
13146
13148
14486
13165
14588
Other (please specify)
5.
OR - What Cayuga County ZIP Code do you live in?
13064
13156
13143
13111
13033
13113
13140
13166
13117
13021
13024
13034
13160
13147
13026
13118
13081
13071
13092
Other (please specify)
*
6.
Which of the following best describes your household?
(Required.)
Single
Two Adults, no Children
Single Parent Woman
Single Parent Man
Single Parent Non Binary
Two Parent Household
Non-related Adults with Children
Multigenerational Household
Other (please specify)
*
7.
What is your gender? Please check all that apply.
(Required.)
Woman/Girl
Man/Boy
Non-binary
Gender not listed here
I’d rather not say
Other (please specify)
*
8.
Please select one of the following:
(Required.)
Hispanic, Latino or Spanish Origins
Not Hispanic, Latino, or Spanish Origins
*
9.
Please indicate your race/ethnicity by checking all the categories that apply to you:
(Required.)
American Indian/Alaska Native
Asian
Black/African American
Hawaiian Native/Pacific Islander
White
Multi-Race (two or more of the above)
Other (please specify)
*
10.
What is your first or native language?
(Required.)
English
Spanish
Other (please specify)
*
11.
What is the highest level of education you have completed? (Please check one.)
(Required.)
8th grade or below
9th – 12th grade, no diploma
High school diploma or GED
Some college or a training certificate (for instance, CNA, CDL)
2 year degree (A.A. etc.)
4 year degree (B.A., B.S., etc.)
Master’s degree or beyond
Current Progress,
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