Buffalo County Community Response Survey

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* 1. What zip-code do you currently live in?

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* 2. How many people currently live in your household?

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* 3. Do you have any children currently living in your household?

Yes

If yes, what are their ages?

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* 4. What is your gender?

Male

Female

Prefer not to specify

Other (please specify)

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* 5. What is your age?

Under 19

19-24

25-34

35-44

45-54

55-64

65+

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* 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)

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* 7. What/who do you trust the most to receive information related to coronavirus? (one or more options)

Trusted Websites (CDC/WHO)

Radio

Social Media

Family/Friends

Community Health Workers/Organizations

Community Leaders/Organizations

Religious Leaders/Organizations

Other (please specify)

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* 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

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* 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:

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* 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:

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* 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:

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* 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:

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* 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:

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* 14. What is your primary concern for yourself and your family today?

Food

Rent/Mortgage

Employment

Transportation

Healthcare

Access to Services

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* 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)

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* 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)

Buffalo County Community Response Survey

Question Title

* 1. What zip-code do you currently live in?

Question Title

* 2. How many people currently live in your household?

Question Title

* 3. Do you have any children currently living in your household?

Question Title

* 4. What is your gender?

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* 5. What is your age?

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* 6. What is your race?

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* 7. What/who do you trust the most to receive information related to coronavirus? (one or more options)

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* 8. What is the highest grade or year of school you completed?

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* 9. What is your current employment status?

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* 10. How concerned are you about paying for your rent/mortgage?

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* 11. How concerned are you about having enough food for yourself and your family?

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* 12. How concerned are you about having transportation?

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* 13. How concerned are you about being able to see a doctor?

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* 14. What is your primary concern for yourself and your family today?

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* 15. How are you taking care of yourself and being hopeful for the future of your community?

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* 16. What resources are you looking for and unable to find at this time in your community?

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* 17. Please list any other concerns or thoughts you may have: