Resident Survey
1.
At the present time, how easy is it for you to meet your basic needs and the needs of your family, given your monthly income? (check one)
Difficult to Meet Our Needs
Somewhat Difficult to Meet Our Needs
Somewhat Easy to Meet Our Needs
Easy to Meet Our Needs
Difficult to Meet Our Needs
Somewhat Difficult to Meet Our Needs
Somewhat Easy to Meet Our Needs
Easy to Meet Our Needs
2.
How connected do you feel to your neighbors? (check one)
Not at All
A Little
Somewhat
A Lot
Not at All
A Little
Somewhat
A Lot
3.
Overall, how would you rate your physical health?
Poor
Fair
Good
Excellent
Poor
Fair
Good
Excellent
4.
Overall, how would you rate your mental health?
Poor
Fair
Good
Excellent
Poor
Fair
Good
Excellent
5.
Imagine a ladder with steps numbered from zero at the bottom to ten at the top. The top of the ladder (10) represents the best possible life for you and the bottom of the ladder (1) represents your worst possible life.
On which step of the ladder would you say you personally feel you stand at this time?
Bottom Step (1)
2
3
4
5
6
7
8
9
Top Step (10)
Bottom Step (1)
2
3
4
5
6
7
8
9
Top Step (10)
6.
On which step do you think you will stand about five years from now?
Bottom Step (1)
2
3
4
5
6
7
8
9
Top Step (10)
Bottom Step (1)
2
3
4
5
6
7
8
9
Top Step (10)
7.
How easy it is to access the services and supports you need in Eaton County? (check one)
Difficult to Access Services
Somewhat Difficult to Access Services
Somewhat Easy to Access Services
Easy to Access Services
Difficult to Access Services
Somewhat Difficult to Access Services
Somewhat Easy to Access Services
Easy to Access Services
8.
How easy is it for you to access affordable housing in Eaton County? (check one)
Difficult
Somewhat Difficult
Somewhat Easy
Easy
Difficult
Somewhat Difficult
Somewhat Easy
Easy
9.
Have you ever called 211?
Yes
No
10.
IF YES, when you called 211, what happened? (check one)
I couldn't find a resource that met my needs
The resource I was referred to did not answer or return my call
I did not qualify for the resource I was referred to
I found a resource and my needs were met
11.
What are the barriers or challenges you experience when trying to access the services and supports you need in Eaton County? (check all that apply)
No programs that meet my needs
I don’t qualify for the services I need
I could not afford the services I qualified for
Not enough providers
Limited office hours
Long waiting list
Transportation
Technology barriers
The system’s too complicated
Feeling of safety / acceptance for seeking services
Other (please specify)
12.
How much do you trust local organizations to understand and support your goals and desires? (check one)
Not at All
A Little
Somewhat
A Lot
Not at All
A Little
Somewhat
A Lot
13.
To what extent are there opportunities in this county for you to provide input or share your ideas? (check one)
There are No Opportunities
There are Some Opportunities
There are Many Opportunities
There are Always Opportunities
There are No Opportunities
There are Some Opportunities
There are Many Opportunities
There are Always Opportunities
14.
Would you like to be more involved in opportunities to provide input or share your ideas?
Yes
Maybe
No
15.
Are people looked down upon in your community for seeking services and supports from local organizations? (check one)
A Lot
Somewhat
A Little
Never
A Lot
Somewhat
A Little
Never
16.
Overall, from 1 being horrible to 10 being terrific, how would you rate living in Eaton County?
Horrible (1)
2
3
4
5
6
7
8
9
Terrific (10)
Horrible (1)
2
3
4
5
6
7
8
9
Terrific (10)
17.
How hopeful do you feel about your future?
Not at All
Somewhat
A Little
A Lot
Not at All
Somewhat
A Little
A Lot
18.
What is your greatest need or concern today? (check one)
Lack of affordable healthy food
Lack of affordable, safe housing
Lack of transportation
Unemployment
Too little employment
Access to affordable health care
Access to affordable mental health care
Loneliness
Child care
Lack of physical activity
Other (please specify)
19.
What are your goals and dreams for yourself or your family?
20.
What can your community do to help you achieve those goals and dreams?
