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* 1. In what city do you live or which city is the nearest to your residence?

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* 2. Which of the following describes your position in the community?

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* 3. Please rate the following issues with youth (ages 0 to 19) in our community.

  Minor Emerging Moderate Considerable Major
Academic struggles
Alcohol/Drug use or abuse
Boredom
Bullying, including online or cyber bullying
Child Abuse and/or Neglect
Cyber/internet use, abuse or addiction
Delinquency
Disregard for Authority/disruptive behavior
Emotional disturbance/depression
Family conflict/dysfunction
Homelessness
Household violence
Issues affecting LGBTQ+ youth
Mental health and other related problems
Parenting challenges/skills
Poor social and/or life skills
Poverty
Quality Childcare/early childhood education
Racism
Runaway youth
Self-esteem/self-efficacy problems
Services for children and families with special needs
Teen pregnancy
Tobacco use, includes cigarettes, smokeless tobacco, dip, vaping or juuling
Truancy
Victims of Crime

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* 4. Which of these is our community's biggest problem? Select no more than two.

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* 5. Are there any other social problems which were not listed in question 3 and needs focus?

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* 6. Please rate from least beneficial to highly beneficial the following services in order of benefit to youth (0-19) in our community.

  Least beneficial Mildly beneficial Moderately beneficial Highly beneficial
After school prevention and diversion program
Alcohol/drug/tobacco prevention and education
Bullying prevention
Community service program and opportunities for youth
Educational services about Adverse Childhood Experiences and Trauma related to children
First Time Offender Program
Housing for homeless youth
Individual, family and group counseling services
Life skills education
Parenting classes and support groups
Residential parental placement program for youth in need of different housing
School based prevention programs
School based counseling services
Services for children and families with special needs
Services for child victims of crime
Social and relational skills development and education
Summer prevention and diversion programs
Trauma informed services
Youth recreation and activities

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* 7. Please identify barriers you experience or have heard about when seeking services or participating in services with the Community Children's Shelter and Family Service Center, Inc.

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* 8. How do you prefer to get information from and about the Community Children's Shelter and Family Service Center, Inc?

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* 9. If you were to donate to the Community Children's Shelter and Family Service Center, Inc., what is your preferred method of donation?

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* 10. What is your age?

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* 11. With which race do you identify? (Select all that apply)

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* 12. What is your current educational level?

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* 13. If you would like to participate in additional, in-depth conversations, please leave your email information to be contacted by the Children's Shelter. Your information will be kept private. 

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