Community Needs Assessment Survey

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* 1. Are you an adult aged 46 or older?

Yes

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* 2. Do you have reliable housing?

Yes

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* 3. Does anyone in your household have a physical or mental disability?

Yes

No Response

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* 4. How would you rate the following issues for your household?

	Serious Problem	Moderate Problem	Not a Problem	Does not apply to my household
Availability of job training opportunities	Availability of job training opportunities Serious Problem	Availability of job training opportunities Moderate Problem	Availability of job training opportunities Not a Problem	Availability of job training opportunities Does not apply to my household	Availability of job training opportunities
Availability of jobs for adults	Availability of jobs for adults Serious Problem	Availability of jobs for adults Moderate Problem	Availability of jobs for adults Not a Problem	Availability of jobs for adults Does not apply to my household	Availability of jobs for adults
Availability of jobs for youth	Availability of jobs for youth Serious Problem	Availability of jobs for youth Moderate Problem	Availability of jobs for youth Not a Problem	Availability of jobs for youth Does not apply to my household	Availability of jobs for youth
Education	Education Serious Problem	Education Moderate Problem	Education Not a Problem	Education Does not apply to my household	Education
Child-care services	Child-care services Serious Problem	Child-care services Moderate Problem	Child-care services Not a Problem	Child-care services Does not apply to my household	Child-care services
Cost of living	Cost of living Serious Problem	Cost of living Moderate Problem	Cost of living Not a Problem	Cost of living Does not apply to my household	Cost of living
Income/Wages	Income/Wages Serious Problem	Income/Wages Moderate Problem	Income/Wages Not a Problem	Income/Wages Does not apply to my household	Income/Wages
Debt	Debt Serious Problem	Debt Moderate Problem	Debt Not a Problem	Debt Does not apply to my household	Debt
Financial security	Financial security Serious Problem	Financial security Moderate Problem	Financial security Not a Problem	Financial security Does not apply to my household	Financial security
Availability of financial services	Availability of financial services Serious Problem	Availability of financial services Moderate Problem	Availability of financial services Not a Problem	Availability of financial services Does not apply to my household	Availability of financial services
Availability of financial counseling	Availability of financial counseling Serious Problem	Availability of financial counseling Moderate Problem	Availability of financial counseling Not a Problem	Availability of financial counseling Does not apply to my household	Availability of financial counseling
Elderly living assistance (67+)	Elderly living assistance (67+) Serious Problem	Elderly living assistance (67+) Moderate Problem	Elderly living assistance (67+) Not a Problem	Elderly living assistance (67+) Does not apply to my household	Elderly living assistance (67+)
Availability of health care	Availability of health care Serious Problem	Availability of health care Moderate Problem	Availability of health care Not a Problem	Availability of health care Does not apply to my household	Availability of health care
Seeking employment with a criminal record	Seeking employment with a criminal record Serious Problem	Seeking employment with a criminal record Moderate Problem	Seeking employment with a criminal record Not a Problem	Seeking employment with a criminal record Does not apply to my household	Seeking employment with a criminal record
Obtaining a degree/diploma with a criminal record	Obtaining a degree/diploma with a criminal record Serious Problem	Obtaining a degree/diploma with a criminal record Moderate Problem	Obtaining a degree/diploma with a criminal record Not a Problem	Obtaining a degree/diploma with a criminal record Does not apply to my household	Obtaining a degree/diploma with a criminal record
Substance abuse services	Substance abuse services Serious Problem	Substance abuse services Moderate Problem	Substance abuse services Not a Problem	Substance abuse services Does not apply to my household	Substance abuse services
Substance abuse treatment	Substance abuse treatment Serious Problem	Substance abuse treatment Moderate Problem	Substance abuse treatment Not a Problem	Substance abuse treatment Does not apply to my household	Substance abuse treatment
Mental health	Mental health Serious Problem	Mental health Moderate Problem	Mental health Not a Problem	Mental health Does not apply to my household	Mental health
Loneliness	Loneliness Serious Problem	Loneliness Moderate Problem	Loneliness Not a Problem	Loneliness Does not apply to my household	Loneliness
Domestic violence	Domestic violence Serious Problem	Domestic violence Moderate Problem	Domestic violence Not a Problem	Domestic violence Does not apply to my household	Domestic violence
Food insecurity	Food insecurity Serious Problem	Food insecurity Moderate Problem	Food insecurity Not a Problem	Food insecurity Does not apply to my household	Food insecurity
Physical and/or emotionally safety	Physical and/or emotionally safety Serious Problem	Physical and/or emotionally safety Moderate Problem	Physical and/or emotionally safety Not a Problem	Physical and/or emotionally safety Does not apply to my household	Physical and/or emotionally safety
Medical care	Medical care Serious Problem	Medical care Moderate Problem	Medical care Not a Problem	Medical care Does not apply to my household	Medical care

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* 5. What are the things that make it difficult for you or other adults in your household to find and/or keep work? (check all that apply)

Lack of affordable childcare

Caring for a family member who is sick or disabled

Language barriers

Lack of transportation

Lack of experience

Lack of job training

Lack of job opportunities

No high school diploma or GED

No college degree

Physical disability

Criminal record

No Driver's License

No cell phone

No computer

Evolving technology

Mental health concerns

Limited income

Primary caregiver for another person

Other (please specify)

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* 6. Do you or any others in your household have an interest in the following? (check all that apply)

GED/Adult education

Vocational training

Increasing income

Obtaining employment

Upward mobility from current job/career

Financial wellness

Debt management

Higher education

Spirituality

Body improvement (Dance, Yoga, etc.)

Elder LGBTQ+ law

Art

Recreation and leisure

Wellness

Music

Sexual health

End of life planning

Legal services

Locating housing

Cooking

Other (please specify)

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* 7. Do you or another adult in your household have difficulty with any of the following? (check all that apply)

Reading

Math

Speaking English

Reading in English

Writing in English

Using a computer

Transportation

Using RTD/public transportation

Scheduling appointments

Scanning QR codes

Using a phone

Using an iPad or other tablet

Using a printer

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* 8. What are the primary healthcare needs of your household? (check all that apply)

Primary healthcare

Pediatric (child) care

Prenatal (pregnancy) care

Pet care

Dental care

Healthcare education/prevention

Nutrition

Exercise programs

Services to help alleviate stress, anxiety, depression

Assistance with daily living for elderly/disabled residents

Health screening services

Grief counseling/support

LGBTQ+ inclusive healthcare

Residential facility options

Independent living

Substance abuse treatment

Community relationships

Stop smoking programs

Stop drinking programs

Hearing

Vision

Veteran services

Social Security Insurance

Social Security Disability Insurance

Transportation to healthcare services

Mental health

Fitness

Weight management

Home improvement/modifications

Reproductive health

Food assistance

Meal preperation

Medicare

Dementia

Parkinson's

Alzheimer's

Other (please specify)

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* 9. Please rank the following group interests from 1-5. (1 being the most interested, 5 being the least)

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* 10. What is your gender? (please check)

Identifies as Female

Identifies as Male

Non-binary

Transgender

Gender Fluid

Gender Non-conforming

Two-Spirit

Other (please specify)

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* 11. What is your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 12. Please use the remaining space to list any and all remaining questions, comments, and/or concerns that will assist us in better serving our community members here at The Center on Colfax.