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CAPIC Community Needs Survey
Please Complete By March 1, 2020
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
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
3.
Are you able to pay your bills on time each month?
Yes
No
Unsure
4.
Do you currently have at least $500 set aside for emergencies?
Yes
No
Unsure
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)
6.
Where do you live?
Chelsea
Revere
Winthrop
Somewhere Else
7.
What is your zip code?
8.
What is your Age?
Under 18
18-24
25-44
45-64
65+
9.
What is your Gender?
Male
Female
Non-Binary
Other (please specify)
10.
Are you Hispanic/Latino?
Yes
No
11.
What is your race?
American Indian or Alaskan Native
Asian
Black or African American
White
Native Hawaiian / Other Pacific Islander
Multi-Race
Other (please specify)
12.
What is your Household's monthly income before taxes?
Under $2000 a month (under $24,000 annually)
$2000 - $4000 a month ($24,000 - $48,000 annually)
$4001 - $6000 a month ($48,012 - $72,000 annually)
Over $6,000 a month (Over $72,000 annually)
13.
How many people are in your household (including yourself?
Between 0 and 17 years old:
18 years old and up:
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.
Current Progress,
0 of 14 answered
