Please help us by completing this 45-question survey (which may take only 10-15 minutes). The goal of this survey is to help us identify the needs in our community to connect you with the resources you need. Thank you in advance for your time and support. Survey statistics will not reveal the identity of an individual or any private information.

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* 1. Gender (check the gender you identify with most)

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* 2. Your age range (check one)

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* 3. Have you or a member in your household served in the US military? (check one)

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* 4. How many people live in your household?

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* 5. What best describes your race and ethnicity (check all that apply)

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* 6. Martial Status (check one)

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* 7. Highest Education Level Completed (check one)

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* 8. Please check if any apply

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* 11. Has getting or keeping a good job been hard for you or anyone in your household in the last 12 months?

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* 12. County in which you reside full time (check one)

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* 13. What are the 3 biggest barriers facing individuals and families from improving their quality of life? (check what you believe are the top three)

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* 14. What are three things that would make your life or your community better?

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* 15. Do you and your family have access to as many social organizations, sports or recreation groups as you want to participate in?

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* 16. Which of the following are you active in monthly/weekly/yearly? (check all that apply)

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* 17. Does your extended family live in the area?

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* 18. Are you able to keep in touch with and visit family members as much as you want?

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* 19. Do you feel safe in your home and your neighborhood?

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* 20. How long have you lived in the Magic Valley?

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* 21. In the time you have lived here how many addresses have you had?

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* 22. If you have had more than one address in the time you have lived here what was the cause or causes of moving?

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* 23. Have you every been homeless?

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* 24. Please choose the option that most closely describes your current living situation:

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* 25. What best describes your household: (check one)

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* 26. What best describes your living situation: (check all that apply)

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* 27. Which of the following, if any, housing problems apply to you? (check all the apply)

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* 28. Do any of the following prevent you from buying a home? (check all the apply)

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* 29. Rate these stressors from 1 (low or no stress) to 5 (high stress)

  1 2 3 4 5
Childcare
Personal Health
Transportation
Health Insurance
Legal Matters
Education
Family
Employment

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* 30. How do you manage your stressors? (check all the apply)

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* 31. In the last 12 months have you or anyone in your household: (check all the apply)

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* 32. Is there a local market that sells fresh fruits & vegetables within walking distance of where you live?

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* 33. When you need help with daily problems or an occasional crisis, where are you most likely to go first for advice or resources? (check one)

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* 34. If you or someone in your household needed mental health care, where would you go? (check all the apply)

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* 35. If you or someone in your household need alcohol/drug treatment, where would you go? (check all that apply)

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* 36. Which of these situations apply to you or anyone in your home this last 12 months (check all that apply)

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* 37. If childcare was an issue for getting or keeping a job, what problems did you have? (check all the apply)

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* 38. What kind of childcare (dependent care) do you need?

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* 39. In the last 12 months, which of the following transportation problems has your household experienced? (check all that apply)

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* 40. If public transportation (bus service) were available would you use it?

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* 41. What is your household's gross (pretax) monthly income? (check one)

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* 42. What are the sources of household income? (check all that apply)

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* 43. On a scale from 1 (not important) to 5 (extremely important) please rate how important this service is to your household now.

  1 2 3 4 5
Help finding housing we can afford
Help finding a way to afford rent or mortgage
Childcare
Basic education/English (GED/ESL)
Legal Help
Food (help getting enough food)
Nutritious food (help getting enough fruits and vegetables)
Help with how to buy and cook healthy meals
Transportation that meets my needs
Affordable medical care
Affordable dental care
Affordable prescriptions
Better paying jobs
Help with heating and electric bills
Mental health services or family counseling
Domestic violence shelter and/or counseling services
Drug/alcohol treatment and counseling
Help with basic financial health (budgeting, money management, fixing credit, how to save money, etc.)
Volunteer opportunities to build skills and/or give back to my community

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* 44. Please take a few moments to share your thoughts on how you think we can strengthen our community by helping more people become self-sufficient.

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* 45. What have we not asked you that you feel is important?

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