The needs assessment survey is designed to get your input on what needs your community may have.  Please answer the questions based on your community needs, stating whether the item is most needed, somewhat needed, not needed, or you don't know.

First, we would like to collect some demographic data about you.

What county do you live in?

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* 1. What county do you live in?

Relationship with Community Action Program, Inc. of Western Indiana

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* 2. Relationship with Community Action Program, Inc. of Western Indiana

Gender

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* 3. Gender

Age

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* 4. Age

Race

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* 5. Race

Ethnicity

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* 6. Ethnicity

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