INSTRUCTIONS: Please mark your answer for each question to the best of your ability.

The confidential information collected from this Community Assessment assists GROW South Dakota, a statewide agency, to provide you and your community with quality programs and services that are needed to sustain our rural communities. This information also helps us plan for new programs and services.

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* 1. What is your relationship with GROW South Dakota? (Select all that apply. Select at least one.)

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* 2. What is your gender?

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* 3. What is your age?

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* 4. How many people live in your household, including yourself?

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* 5. Please check the answer that best describes the education level of the head of your household.

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* 6. Check one that describes your employment status.

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* 7. Check one that describes your health care coverage.

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* 8. What answer best describes your race?

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* 9. What answer best describes your Hispanic ethnicity?

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* 10. What is your annual income? 

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* 11. Check one that best describes where you live.

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* 12. Are you a Veteran?

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* 13. List two things you, your family and friends value most about living in your community:

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* 15. What 5-digit zip code do you use in your mailing address?

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* 16. Please rate the following in terms of their level of need in your HOUSEHOLD. 1 = not a need; 5 = very high need

  1 (not a need) 2 3 4 5 (very high need)
Business Counseling or Training
Business Loan to Start or Expand a Business
Child Support Enforcement
Emergency Assistance – Food, Clothing, Shelter, Utility Assistance
Financial Coaching - Manage money or repair credit
Health and wellness information and services
Home Improvements
Home Loans (Mortgage, Down Payment, Closing Cost)
Homelessness services or prevention
Homeownership Education
Jobs
Rental Housing or Rental Assistance
Weatherization to Improve Home Energy Efficiency

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* 17. Please rate the following in terms of their level of need in your COMMUNITY. 1 = not a need; 5 = very high need

  1 (not a need) 2 3 4 5 (very high need)
Business Counseling or Training
Business Loan to Start or Expand a Business
Child Support Enforcement
Emergency Assistance – Food, Clothing, Shelter, Utility Assistance
Financial Coaching - Manage money or repair credit
Health and wellness information and services
Home Improvements
Home Loans (Mortgage, Down Payment, Closing Cost)
Homelessness services or prevention
Homeownership Education
Jobs
Rental Housing or Rental Assistance
Weatherization to Improve Home Energy Efficiency

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* 18. For each of the following community assets and services, please rate your level of need in your community:

  Not a Need Moderate Need High Need
Activities/services for seniors
Activities/services for youth
Adequate and nutritious sources of food (e.g., grocery stores, restaurants, farmer's market)
Affordable Homes for Purchase
Businesses that Meet Our Needs
Community Education/Training Opportunities
Day Care Services
Health and wellness information and services
Jobs/Business Opportunities
Rental Housing
Support/welcoming services for newcomers, immigrants, and new citizens

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* 19. As a nonprofit lender, GROW South Dakota strives to work with our local lending institutions (banks, credit unions, etc) to provide affordable loans for home ownership.  This question is in relation to borrowing money to purchase a home. Do you feel you would you be able to obtain a loan through a bank or other financial institution to purchase a home?

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