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Community Needs Assessment 2026
Part One: Demographics
Participant Profile
1.
Are you completing this survey as a representative of an agency? If yes, please list agency and skip to part two.
2.
Are you a resident of Cleveland County?
Yes
No
3.
City
4.
Zip code
5.
Age
6.
Race
7.
Ethnicity
8.
Tribal Affiliation (if applicable)
9.
Primary Language in the home
10.
What best describes your annual income:
0-20,000
20-30,000
30-40,000
40-60,000
Above 60,000
11.
How many people in your household:
12.
Number of children (under 18) in household:
13.
Do you have an adult family member who receives care in your home?
Yes
No
If yes, what kind of care do they receive?
14.
Do you care for a child with special health care needs:
Yes
No
15.
Highest level of education completed: