COVID-19 Community Needs Assessment

Question Title

* 1. Please select which county you are living in

Calhoun County

Dewitt County

Goliad County

Gonzales County

Jackson County

Lavaca County

Victoria County

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* 2. What is your zip code?

Question Title

* 3. Please select our age.

18-24

25-34

35-44

45-54

55-64

65+

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* 4. Are you, or someone in the household, disabled?

Yes

Question Title

* 5. What local needs have you seen arise due to the COVID-19 pandemic?

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* 6. How would you like to see COVID-19 funds used in your community?

Question Title

* 7. Please rate the following on a scale of 1 through 6. 1 being the least important and 6 most important.
What is your primary concern currently?

Housing Payments

N/A

Medication Assistance

N/A

Utility Payments

N/A

Food Assistance

N/A

Health Insurance Assistance

N/A

Medical Supplies Assistance

N/A

Question Title

* 8. What is your primary concern, personally, once the pandemic ends for you and your family?

Housing Payments

N/A

Utility Payments

N/A

Medication Assistance

N/A

Health Insurance Assistance

N/A

Medical Supplies Assistance

N/A

Food Assistance

N/A

COVID-19 Community Needs Assessment

Question Title

* 1. Please select which county you are living in

Question Title

* 2. What is your zip code?

Question Title

* 3. Please select our age.

Question Title

* 4. Are you, or someone in the household, disabled?

Question Title

* 5. What local needs have you seen arise due to the COVID-19 pandemic?

Question Title

* 6. How would you like to see COVID-19 funds used in your community?

Question Title

* 7. Please rate the following on a scale of 1 through 6. 1 being the least important and 6 most important.
What is your primary concern currently?

Question Title

* 8. What is your primary concern, personally, once the pandemic ends for you and your family?

Question Title

* 9. What is your primary concern for the community, once the pandemic ends?

Question Title

* 10. Please tell us about any concerns not previously listed.

COVID-19 Community Needs Assessment

Question Title

* 1. Please select which county you are living in

Question Title

* 2. What is your zip code?

Question Title

* 3. Please select our age.

Question Title

* 4. Are you, or someone in the household, disabled?

Question Title

* 5. What local needs have you seen arise due to the COVID-19 pandemic?

Question Title

* 6. How would you like to see COVID-19 funds used in your community?

Question Title

* 7. Please rate the following on a scale of 1 through 6. 1 being the least important and 6 most important. What is your primary concern currently?

Question Title

* 8. What is your primary concern, personally, once the pandemic ends for you and your family?

Question Title

* 9. What is your primary concern for the community, once the pandemic ends?

Question Title

* 10. Please tell us about any concerns not previously listed.

* 7. Please rate the following on a scale of 1 through 6. 1 being the least important and 6 most important.
What is your primary concern currently?