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* 2. What is your 5 digit zipcode?

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* 3. What sector best describes your organization? (select one)

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* 4. Please indicate the categories that best describe the primary recipients of your services. (check all that apply)

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* 5. What is/are the primary services provided by your organization? (check all that apply)

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* 6. Have you referred clients to CAANE for services not provided by your agency?

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* 7. In your professional opinion, are there unmet individual/family needs for which you are not able to provide a referral?

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* 8. What issues concern you most in YOUR COMMUNITY? (choose only 5 issues, then rank them from 1 to 5 with 1 being the least concern and 5 being the greatest concern)

  1 2 3 4 5
Literacy Needs, access to library, bookmobile, etc.
Need for more job training
Not enough jobs
Adult education opportunities
Homelessness
Affordable, safe housing
Lack of transportation
Services for disabled children and families
Teen Pregnancy
Food for the low-income
Food for the Elderly
Schools and education for children
Cost of utilities (gas, water, electricity)
Child Abuse & Neglect
Alcohol & Substance Abuse
Domestic violence awareness

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* 9. What issues concern FAMILIES that you serve? (choose only 5 issues, then rank them from 1 to 5 with 1 being the least concern and 5 being the greatest concern)

  1 2 3 4 5
Job training
Employment
Food
Education for adults (GED, etc.)
Lack of books, reading materials in my home
Paying necessary bills (rent, electric, phone)
Affordable, safe housing
Transportation and fuel costs
Child care for infants, toddlers & after school
Services for disabled child
Getting dental care (adults)
Getting mental health services
Getting Child Support Assistance
Incarcerated Parents
Getting Domestic Violence Assistance
Money Management/Budgeting
Home Repair

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* 10. Please list suggestions of how your organization would address these issues if not limited by funding barriers.

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* 11. Are there community/family needs that we have not asked about that you feel are important?

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