* 1. Which of the following best describes the organization you represent?

* 2. What town/city does your organization operate in/cover?

* 3. How long have you been at your organization/business?

* 4. What do you see as the current needs in your community, please rate each of the issues below by

  Critical concern Somewhat a concern Not at all a concern
Food costs
Access to healthy foods
Housing /rent costs
Home repairs
Reducing utility costs
Increasing income
Help with managing money
Help paying utility bill(s)
Credit card or loan debt
Parenting support and education
Children’s education/tutoring
High school drop-outs
Affordable daycare or before/after school care
Neighborhood Safety and Security
Paying for college/higher education
Health Insurance/ Healthcare Costs
Dental and/or Vision Care
Programs for youth/teens
Juvenile Delinquency/Crime
Drug or Alcohol Abuse
Domestic Violence
Programs and services for Senior Citizens
Services for Disabled people
Veterans’ Services
Mental Health Services
Language Barrier(s)
Immigration/citizenship issues
Incarceration /reintegration issues
Finding a job
Job Training

* 5. Which ONE item of the list above is MOST important need right now overall in your community (or communities)?

* 6. Please share any comments about the availability of services or other unmet needs in your community from your perspective? Any suggestions for improvement in services or quality of living?