Question Title

* 1. Please select the County you represent:

Question Title

* 2. What is your gender?

Question Title

* 3. What is your age group?

Question Title

* 4. What is your marital status?

Question Title

* 5. What is your race?

Question Title

* 6. Are you

Question Title

* 7. What is your highest level of education completed?

Question Title

* 8. Employment Status (Check all that apply)?

Question Title

* 9. Are you

Question Title

* 10. Are you

Question Title

* 11. Are you

Question Title

* 12. Annual household income?

The following survey questions were created to better understand community needs and issues.

Question Title

* 13. Which of the following do you see as the major problems in your community? (Check all that apply.)

Question Title

* 14. Which of the following EMPLOYMENT needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 15. Which of the following EDUCATION needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 16. Which of the following FINANCIAL needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 17. Which of the following HOUSING needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 18. Which of the following HEALTH needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 19. Which of the following COMMUNITY INVOLVEMENT needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 20. Which of the following TRANSPORTATION needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 21. Which of the following OTHER needs do you feel should be addressed in your community? (Check all that apply.)

Question Title

* 22. If you have additional comments, please provide them in the space below. We appreciate and value your input.

GLCAP would like to thank you for taking the time to give us your input.

Your input and comments provide valuable information for planning our programs and services.

T