CAANEAL Community Needs Assessment Partner Survey

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* 1. In what county is your organization/business located?

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* 2. What is your 5 digit zipcode?

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

Government

Social Services

Private

Healthcare

Education

Non-Profit

Other (please specify)

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

Homeless individuals/families

Low-income individuals/families

Individuals with disabilities

Individuals with mental health needs

Individuals who speak English as a second language

Individuals who are presently or formerly incarcerated

All individuals regardless of classification

Youth

Seniors

Veterans/Military families

Other (please specify)

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

Abuse/neglect prevention

Adult education

Child Advocacy

Disaster Assistance

Early childhood/Pre-K

Faith Base services

Food Assistance

Hospice Care

Housing/Home repair

Job Training/job opportunities

Medical Assistance/Healthcare

Mental Health

Mentoring

Money Management/Budgeting

Rehabilitation

Senior Assistance

Utility Services

Volunteer Outreach

Youth Education (K-12)

Other (please specify)

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

Yes

If yes, please explain.

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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?

Yes

If yes, please explain.

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

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

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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?

Yes

If yes, please explain.

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* 1. In what county is your organization/business located?

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* 2. What is your 5 digit zipcode?

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

Question Title

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

Question Title

* 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 CAANEAL 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)

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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)

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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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* 12. Thank you for participating in our survey! If there are any further comments please let us know.