Farmworker Community Partner Survey Question Title * 1. What is your contact information email, phone Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK Question Title * 2. What services does your organization provide to farmworkers OK Question Title * 3. Have you heard of FRLS and the services we provide OK Question Title * 4. Please look at the following list of problems and check YES or NO if a farmworker you know experienced that specific problem in the last 12 months for us to better understand the legal needs of you and your community.Please select the top 5 legal problems that you think farmworker individuals and families face. Use 1 for the most important, 2 for the next most important, 3 for the 3rd most important, 4th and 5th. Select ONLY 5. Yes or No Rank Problems with a Landlord shut off utilities (water or electric) or locked you out of your home/Eviction Yes No Problems with a Landlord shut off utilities (water or electric) or locked you out of your home/Eviction Yes or No menu 1 2 3 4 5 Problems with a Landlord shut off utilities (water or electric) or locked you out of your home/Eviction Rank menu Difficulty finding affordable housing Yes No Difficulty finding affordable housing Yes or No menu 1 2 3 4 5 Difficulty finding affordable housing Rank menu Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability). Yes No Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability). Yes or No menu 1 2 3 4 5 Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability). Rank menu Timekeeping or Payroll Records Issue Yes No Timekeeping or Payroll Records Issue Yes or No menu 1 2 3 4 5 Timekeeping or Payroll Records Issue Rank menu Tax problems (issues with the IRS or county property taxes). Yes No Tax problems (issues with the IRS or county property taxes). Yes or No menu 1 2 3 4 5 Tax problems (issues with the IRS or county property taxes). Rank menu Consumer fraud (e.g. telemarketing scam, identify theft, fake product). Yes No Consumer fraud (e.g. telemarketing scam, identify theft, fake product). Yes or No menu 1 2 3 4 5 Consumer fraud (e.g. telemarketing scam, identify theft, fake product). Rank menu Difficulties with your child’s school / education (disability, suspension, expulsion, access to alternative schooling, IEPs). Yes No Difficulties with your child’s school / education (disability, suspension, expulsion, access to alternative schooling, IEPs). Yes or No menu 1 2 3 4 5 Difficulties with your child’s school / education (disability, suspension, expulsion, access to alternative schooling, IEPs). Rank menu Problem regarding public benefits (food stamps, disability benefits through Social Security, Medicaid or Medicare). Yes No Problem regarding public benefits (food stamps, disability benefits through Social Security, Medicaid or Medicare). Yes or No menu 1 2 3 4 5 Problem regarding public benefits (food stamps, disability benefits through Social Security, Medicaid or Medicare). Rank menu Job discrimination (in hiring or on the job due to disability, race, religion, gender, national origin or sexual orientation/gender identify) and/or Job Displacement Yes No Job discrimination (in hiring or on the job due to disability, race, religion, gender, national origin or sexual orientation/gender identify) and/or Job Displacement Yes or No menu 1 2 3 4 5 Job discrimination (in hiring or on the job due to disability, race, religion, gender, national origin or sexual orientation/gender identify) and/or Job Displacement Rank menu Problems with worker’s compensation or unemployment insurance Yes No Problems with worker’s compensation or unemployment insurance Yes or No menu 1 2 3 4 5 Problems with worker’s compensation or unemployment insurance Rank menu Barriers (such as lack of child care or transportation) to participating in work and training programs. Yes No Barriers (such as lack of child care or transportation) to participating in work and training programs. Yes or No menu 1 2 3 4 5 Barriers (such as lack of child care or transportation) to participating in work and training programs. Rank menu Problems related to immigration or naturalization Yes No Problems related to immigration or naturalization Yes or No menu 1 2 3 4 5 Problems related to immigration or naturalization Rank menu Victim of human trafficking (e.g. cannot safely quit a job, working to pay off a debt instead of pay, employer holding on to identification documents). Yes No Victim of human trafficking (e.g. cannot safely quit a job, working to pay off a debt instead of pay, employer holding on to identification documents). Yes or No menu 1 2 3 4 5 Victim of human trafficking (e.g. cannot safely quit a job, working to pay off a debt instead of pay, employer holding on to identification documents). Rank menu H2A worker contract issues (ie, trafficking, contract fraud) Yes No H2A worker contract issues (ie, trafficking, contract fraud) Yes or No menu 1 2 3 4 5 H2A worker contract issues (ie, trafficking, contract fraud) Rank menu Other (please specify) OK Question Title * 5. Do you have suggestions on how our organizations can partner to better assist farmworkers and their families. OK What county does your organization service? OK DONE