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* 1. Which county do you live in?

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* 2. How many people live in your household (including yourself)?

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* 3. What is your household's annual income?

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* 4. What do you think are the top three challenges individuals and families face in eating healthy?

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* 5. What do you think are the top three challenges individuals and families face in obtaining health services (this includes medical, dental, vision and mental health)

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* 6. What are the top three reasons women do not access women's healthcare related to childbirth (breastfeeding, birthing classes, doula services)

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* 7. What do you think are the top three reasons students (preschool through high school) miss school?

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* 8. What do you think are the top three reasons teenagers drop out of school?

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* 9. What do you think are the top three challenges adults (18 or Older) face in improving their education?

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* 10. Do you think our area has enough resources for parents (how to learn to change diapers, how to learn curb unwanted child behaviors, how to interact with your child, how to be your child's first teacher)?

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* 11. What do you think the top three needs are of parents?

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* 12. What do you think are the top three barriers individuals face in obtaining/maintaining employment?

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* 13. What do you think are the top three barriers families are facing in obtaining/maintaining childcare?

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* 14. What do you think are the top three reasons parents do not send their children to an afterschool/summer program?

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* 15. What do you think are the top three barriers individuals and families face with transportation?

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* 16. What do you think are the top three housing barriers individuals and families are facing in our area?

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* 17. Do you think our area has people who are homeless?

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* 18. Do you know any homeless youth in Jefferson or Franklin Counties?

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* 19. Which of our services have you heard of (select all that apply)?

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* 20. How likely are you to refer someone to JFCAC for assistance?

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* 21. Other Comments:

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* 22. If you would like to receive periodic communication from JFCAC, please provide your E-mail address. 

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