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

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* 2. What services does your organization provide to farmworkers

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* 3. Have you heard of FRLS and the services we provide

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* 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	Problems with a Landlord shut off utilities (water or electric) or locked you out of your home/Eviction Yes or No menu	Problems with a Landlord shut off utilities (water or electric) or locked you out of your home/Eviction Rank menu
Difficulty finding affordable housing	Difficulty finding affordable housing Yes or No menu	Difficulty finding affordable housing Rank menu
Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability).	Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability). Yes or No menu	Housing discrimination (Denied housing because of race, religion, gender, national origin, or disability). Rank menu
Timekeeping or Payroll Records Issue	Timekeeping or Payroll Records Issue Yes or No menu	Timekeeping or Payroll Records Issue Rank menu
Tax problems (issues with the IRS or county property taxes).	Tax problems (issues with the IRS or county property taxes). Yes or No menu	Tax problems (issues with the IRS or county property taxes). Rank menu
Consumer fraud (e.g. telemarketing scam, identify theft, fake product).	Consumer fraud (e.g. telemarketing scam, identify theft, fake product). Yes or No menu	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).	Difficulties with your child’s school / education (disability, suspension, expulsion, access to alternative schooling, IEPs). Yes or No menu	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).	Problem regarding public benefits (food stamps, disability benefits through Social Security, Medicaid or Medicare). Yes or No menu	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	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	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	Problems with worker’s compensation or unemployment insurance Yes or No menu	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.	Barriers (such as lack of child care or transportation) to participating in work and training programs. Yes or No menu	Barriers (such as lack of child care or transportation) to participating in work and training programs. Rank menu
Problems related to immigration or naturalization	Problems related to immigration or naturalization Yes or No menu	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).	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	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)	H2A worker contract issues (ie, trafficking, contract fraud) Yes or No menu	H2A worker contract issues (ie, trafficking, contract fraud) Rank menu

Other (please specify)

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* 5. Do you have suggestions on how our organizations can partner to better assist farmworkers and their families.

What county does your organization service?