The City of Lakin is conducting a survey to assess the need for improvements in public facilities and services. Some improvement projects may be eligible for Federal funding. Your answers will remain confidential. We thank you so much for your time and effort. This helps unlock funding for our community-wide projects!
Section 1: Household Information

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* 1. Name and Address or Identification Code:

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* 2. How many persons live at this address?

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* 3. How many persons are unrelated individuals (not members of a family)?

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* 4. How many families (persons related by birth, marriage, or adoption) live at this address?

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* 5. For each family or unrelated individual, provide the following details:

Section 2: Family Income Information

For each family or unrelated individual at this address, please answer the following questions:

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* 6. What is the size of Family 1 (number of persons)?

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* 7. Is the total income of Family 1:

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* 8. What is the size of Family 2 (number of persons)?

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* 9. Is the total income of Family 2:

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* 10. What is the size of Family 3 (number of persons)?

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* 11. Is the total income of Family 3:

Section 3: Demographic Information

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* 12. How many persons at this address identify as the following races or ethnicities?

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* 13. How many persons at this address are of Hispanic or Latino origin?

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* 14. Is there a female head of household living at this address?

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* 15. Are there any persons with disabilities living at this address?

(Note: A disabled person is defined as someone with a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment.)
Section 4: Housing and Infrastructure

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* 16. What type of housing do you live in?

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* 17. Is your housing:

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* 18. Do you have concerns about the condition of your home?

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* 19. Does your home have access to reliable utilities? (check all that apply)

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* 20. What improvements to public infrastructure do you believe are most needed in your community? (check all that apply)

Section 5: Public Services and Community Needs

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* 21. Which public services do you currently use? (check all that apply)

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* 22. Are there public services you feel are inadequate or missing in your area?

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* 23. Do you have access to affordable healthcare services?

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* 24. Are childcare services accessible and affordable for your family?

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* 25. What types of programs or services would improve quality of life in your community? (check all that apply)

Section 6: Transportation

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* 26. What is your primary mode of transportation?

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* 27. Do you have reliable access to transportation?

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* 28. What improvements to transportation services are most needed in your area?

Section 7: Community Involvement

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* 29. Do you feel included in community decision-making processes?

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* 30. What methods of communication work best for staying informed about community initiatives?

Section 8: General Feedback

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* 31. What do you consider to be the biggest challenge facing your community?

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* 32. Are there any additional comments or suggestions you would like to provide?

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