Buffalo County Community Response Survey Question Title * 1. What zip-code do you currently live in? OK Question Title * 2. How many people currently live in your household? 1 2 3 4 5+ OK Question Title * 3. Do you have any children currently living in your household? Yes No If yes, what are their ages? OK Question Title * 4. What is your gender? Male Female Prefer not to specify Other (please specify) OK Question Title * 5. What is your age? Under 19 19-24 25-34 35-44 45-54 55-64 65+ OK Question Title * 6. What is your race? White Black or African American American Indian or Alaska Native Asian Pacific Islander Hispanic/Latino(a) Don't know/Prefer not to answer Other (please specify) OK Question Title * 7. What/who do you trust the most to receive information related to coronavirus? (one or more options) Trusted Websites (CDC/WHO) Radio TV Social Media Family/Friends Community Health Workers/Organizations Community Leaders/Organizations Religious Leaders/Organizations Other (please specify) OK Question Title * 8. What is the highest grade or year of school you completed? Never attended school or only attended kindergarten Grades 1-8 Grades 9-11 Grade 12 or GED (High School Graduate) College 1-3 years (Some college or technical school) College 4 years or more (College graduate) Don't know/Prefer not to answer OK Question Title * 9. What is your current employment status? Employed Full-Time Employed Part-Time Unemployed Reduced work hours due to COVID19 Unemployed or layoff due to COVID19 Please list any specific concerns you have about employment: OK Question Title * 10. How concerned are you about paying for your rent/mortgage? Very Concerned Slightly Concerned Not Concerned At All Please list any specific concerns you have about rent/mortgages: OK Question Title * 11. How concerned are you about having enough food for yourself and your family? Very Concerned Slightly Concerned Not Concerned At All Please list any specific concerns you have about food: OK Question Title * 12. How concerned are you about having transportation? Very Concerned Slightly Concerned Not Concerned At All Please list any specific concerns you have regarding transportation: OK Question Title * 13. How concerned are you about being able to see a doctor? Very Concerned Slightly Concerned Not Concerned At All Please list any specific concerns you have about seeing a doctor: OK Question Title * 14. What is your primary concern for yourself and your family today? Food Rent/Mortgage Employment Transportation Healthcare Access to Services OK Question Title * 15. How are you taking care of yourself and being hopeful for the future of your community? Time away from news and social media. Being active by walking, yoga, exercising or stretching. Devotions, meditation, or mindfulness. Helping others Socializing with family, friends, co-workers or others. Eating well and getting enough sleep Other (please specify) OK Question Title * 16. What resources are you looking for and unable to find at this time in your community? Self care ideas to reduce anxiety Home schooling ideas to support child education Mental health services, like counseling, therapy Substance abuse treatment services Support groups Business management options during COVID19 Faith services Other (please specify) OK Question Title * 17. Please list any other concerns or thoughts you may have: OK DONE
