CAPIC Community Needs Survey

Question Title

* 1. What do you think are the TOP needs impacting people in your community?
(Check all that apply)

After School/Summer Programs for Children & Youth

Child Care

Jobs

English Classes

Elder Services

Affordable Housing

Ability to pay heating or utility bills

Access to Food

Health Insurance

Mental Health Services

Drug and Alcohol Services

Job Training /Job education

Domestic Violence Services

Safer Neighborhood

Transportation

Ability to budget

legal Assistance

Need for Clothing

Financial Emergencies

Immigration Issues

Discrimination Issues

Access to technology/Internet

Question Title

* 2. Compared to before the COVID-19 pandemic, are you and your family now better off, worse off, or about the same?

Better

About the same

Worse

Question Title

* 3. Are you able to pay your bills on time each month?

Yes

Unsure

Question Title

* 4. Do you currently have at least $500 set aside for emergencies?

Yes

Unsure

Question Title

* 5. What keeps you or your family from feeling more financially stable?

I work full-time but my pay doesn't cover my expenses.

I can only find part-time work.

I can't find a job.

I need more education or training to get work or better work.

Child care is too expensive and/or interferes with my ability to work.

My living expenses (rent/mortgage, heat, food) are too high.

I've had a lot of medical expenses that weren't covered by my insurance.

I don't have reliable transportation

I am on a fixed income (Social Security, pension, etc.) and my income is limited.

Someone in my household is spending money on things we don't need, so there isn't enough left for other expenses

Someone else controls the money and makes decisions I don't agree with.

I or a family member am struggling with addiction.

I or a family member am struggling with mental health issues.

I don't feel safe in my home.

I don't feel safe in my community.

Other (please specify)

Question Title

* 6. Where do you live?

Question Title

* 7. What is your zip code?

Question Title

* 8. What is your Age?

Question Title

* 9. What is your Gender?

Question Title

* 10. Are you Hispanic/Latino?

Yes

Question Title

* 11. What is your race?

Question Title

* 12. What is your Household's monthly income before taxes?

Question Title

* 13. How many people are in your household (including yourself?

Between 0 and 17 years old:

18 years old and up:

Question Title

* 14. If there is anything else you would like to share about your needs or the community in which you live, please write down your thoughts in the space provided below.

CAPIC Community Needs Survey

Please Complete By March 1, 2020

Question Title

* 1. What do you think are the TOP needs impacting people in your community?(Check all that apply)

Question Title

* 2. Compared to before the COVID-19 pandemic, are you and your family now better off, worse off, or about the same?

Question Title

* 3. Are you able to pay your bills on time each month?

Question Title

* 4. Do you currently have at least $500 set aside for emergencies?

Question Title

* 5. What keeps you or your family from feeling more financially stable?

Question Title

* 6. Where do you live?

Question Title

* 7. What is your zip code?

Question Title

* 8. What is your Age?

Question Title

* 9. What is your Gender?

Question Title

* 10. Are you Hispanic/Latino?

Question Title

* 11. What is your race?

Question Title

* 12. What is your Household's monthly income before taxes?

Question Title

* 13. How many people are in your household (including yourself?

Question Title

* 14. If there is anything else you would like to share about your needs or the community in which you live, please write down your thoughts in the space provided below.

* 1. What do you think are the TOP needs impacting people in your community?
(Check all that apply)