Needs Assessment

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.

Question Title

* 1. What county do you live in?

Benton

Boone

Fountain

Montgomery

Parke

Vermillion

Warren

Question Title

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

Staff Member

Client

Member of the Community

Community Partner

Question Title

* 3. Gender

Male

Female

Question Title

* 4. Age

18-29

30-49

50-64

65 and over

Question Title

* 5. Race

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Question Title

* 6. Ethnicity

Hispanic or Latino

Not Hispanic or Latino