United Way Community Needs Assessment

Question Title

* 1. In which county do you reside?

Butte

Glenn

Lassen

Modoc

Plumas

Shasta

Siskiyou

Tehama

Trinity

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* 2. In which city / town / municipality / village do you reside?

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* 3. Please select that choice that includes your age:

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 4. What is your gender?

Female

Male

Other (please specify)