Customer Survey - Tazwood Community Services, Inc. Please take a few minutes to fill out the customer needs assessment survey. The results of this survey will help us to determine the 2021 Community Services Block Grant's programs. OK Question Title * 1. What county do you live in? Tazewell Woodford OK Question Title * 2. What is your zip code? OK Question Title * 3. What is your gender? Male Female OK Question Title * 4. Are you over age 55? Yes No OK Question Title * 5. Are you married or living with a partner? Yes No OK Question Title * 6. Which employment needs could you use help with? (select all that apply) Getting training for the job that I want Getting an education for the job that I want Knowing what jobs are available Learning how to interview for a job Learning how to write a resume Learning how to fill out a job application Learning computer skills to apply for a job Obtaining appropriate clothing for my job Obtaining equipment/tools for my job OK Question Title * 7. Which education needs could you or a family member use help with? select all that apply. Obtaining a high school diploma or GED Obtaining a two year college degree Obtaining a four year college degree Choosing a career Choosing a technical school program Learning how to use a computer Learning or improving communication or language skills Learning English (as a second language ) Getting financial assistance to complete my education Completing college aid forms (including FAFSA) OK Question Title * 8. Which financial and/or legal needs could you or your family use help with? (select all that apply.) Budgeting and managing money Opening a checking or savings account Filling out tax forms Understanding credit scores Solving problems with a credit card or loan company Solving problems with utility or telephone company Solving problems with payday loans Solving bank foreclosure/bankruptcy/repossession problems or issues Solving divorce problems or issues Solving child custody problems or issues Solving child support problems or issues Solving restraining order problems or issues Getting protection in domestic violence situations Getting legal assistance with deportation or immigration issues Getting legal assistance when denied services OK Question Title * 9. Which housing needs could you or your family use help with? (select all that apply) Finding affordable housing that fits my family's needs Getting financial assistance with a down payment or closing cost to buy a home Qualifying for a loan to buy a home Obtaining home ownership education Obtaining renter/tenant rights and responsibilities education Learning basic home repair and property maintenance skills Getting financial assistance with rent payments Getting financial assistance with deposit payments Making my home more energy efficient Making changes to my home for a person with disabilities Getting emergency shelter OK Question Title * 10. Which food and nutrition needs could you or your family use help with? (select all that apply) Getting food from food pantries Having enough food at home Learning how to shop or cook for healthy eating Learning how to stretch my food dollar Getting emergency assistance Getting meals delivered to my home Enrolling in SNAP benefits (food stamps) Learning how to model healthy eating for my children Getting nutritious food during pregnancy Obtaining breast feeding education and assistance OK Question Title * 11. Do you have children under the age of 18 living with you? (if no skip to question 14) Yes No OK Question Title * 12. Which child development needs could you or your family use help with? (select all that apply) Finding child care in a convenient location Finding quality licensed child care Finding affordable child care Finding child care for babies Finding child care for toddlers Finding child care for preschoolers Finding evening or night child care Finding weekend child care Finding weekend child care Finding a quality preschool Finding a before/after school program Preparing my preschool child for public school Getting financial assistance with child care cost Getting financial assistance with school supplies Getting financial assistance with school fees Getting financial assistance with school or club activities. OK Question Title * 13. If you have children under age of 18 living with you, which parenting and/or family support needs could you or your family use help with? (select all that apply) Learning how to discipline my children more effectively. Learning how to communicate and deal with my teenage children Learning how to deal with my children who have displayed bullying or violent behavior Learning to deal with the bullying or violent behavior of my children's friends Learning how to talk to my children about drugs and alcohol Learning how to talk to my children about sex, AIDS, STD's , etc. Learning how to help my children cope with stress, depression or emotional issues Learning how to set goals and plans for my family Communicating better with my children's care provider or teachers OK Question Title * 14. Which transportation needs could you or your family use help with? ( select all that apply.) Having access to public transportation Having dependable transportation to and from work Getting financial assistance to buy a dependable car Getting financial assistance to make car repairs Getting financial assistance to buy car insurance Getting financial assistance to pay car registration or license fees Getting a driver's license Getting to and from medical or dental appointments Getting myself to and from work or school Getting my children to and from child care Getting my children to and from school activities Going shopping and doing errands OK Question Title * 15. Which health needs could you or your family members use help with? (select all that apply) Having affordable health insurance Having affordable dental insurance Having health care available in my community Having dental care available in my community Getting my health insurance questions answered Finding a doctor willing to accept Medicaid Finding a dentist willing to accept Medicaid Getting financial assistance for regular medical checkups Getting financial assistance for regular dental checkups Getting financial assistance for medicine and prescriptions Getting financial assistance for items such as glasses, hearing aids, wheelchairs, etc. Getting financial assistance for long term health care Obtaining family planning or birth control education and assistance Getting good medical care before my baby is born Getting regular check ups, developmental screenings, or physicals for my children Getting my children tested for lead poisoning Getting immunizations for my children Getting treatment for a drug or alcohol problem Dealing with stress, depression or anxiety Dealing with problems related to physical, emotional or sexual abuse Other (please specify) OK Question Title * 16. Which basic needs could you or your family use help with? (select all that apply.) Getting basic furniture, appliances or house wares Getting personal care items such as soap, diapers, toilet paper, etc. Getting shoes and clothing Doing yard work or laundry Managing medications Having a reliable phone Having access to the Internet Getting financial assistance with my utility bills (heating, electric and/or water) OK Question Title * 17. Are there any problems or needs that you or your family faced within the last 12 months that you were unable to get help with? Please list. OK Question Title * 18. What is the ONE thing you would like to see improved in your neighborhood? OK Question Title * 19. How did you learn about Tazwood Community Services, Inc. and their services? Family or friend United Way 211 Brochure or flyer Television Current or former agency customer Health care provider Website/internet Facebook The household I grew up in had received services A state agency Newspaper Local Church Other social service agency Phone book Billboard Mailing Radio Other (please specify) OK Question Title * 20. What are your sources of household income? select all that apply. No income Child support Alimony TANF General Assistance Employment Unemployment income Social Security SSI Social Security Disabilty Pension Other (please specify) OK Question Title * 21. In the past 12 months, how has your household's income changed? Increased Decreased (due to COVID 19) Decreased (NOT due to COVID 19) No change OK Question Title * 22. What time of the day would you prefer to come to one of our locations (office or intake site) for assistance? Select one Weekday hours of 8:00 am - 4:00 pm Weekday evening hours of 5:00 pm to 7:00 pm Saturday hours of 9:00 am to noon I am not able to come to any locations OK Question Title * 23. What services has your household received from our agency within the past 12 months? (select all that apply) Energy Assistance (LIHEAP) Weatheriziation Rent/Mortgage Prescriptions Dental Optical Hearing Aids Car Repair School Supplies Scholarship Summer Camp Water bill OK Question Title * 24. If you know anyone with an incarcerated adult in their family, do they ever talk about particular concerns that could be addressed through... (select all that apply.) Transportation Mentor or after school programs for children Child care assistance Financial assistance Job skills training Stress relief Medical bill assistance Other (please specify) OK Question Title * 25. When you think about your adult family, friends and neighbors how many of them might say something like "there is no money left at the end of month" or "where am I going to find money to pay for that? select one. Almost none (0-5%) Some (6-33%) Quite a few (34-66%) Most (67-95%) Almost everyone (96-100%) OK Question Title * 26. When you think about your family, friends and neighbors, how many of them may have difficulties finding or buying enough quality food to provide at least three meals a day? select one Almost none (0-5%) Some (6-33%) Quite a few (34-66%) Most (67-95%) Almost everyone (96-100%) Other (please specify) OK Question Title * 27. When you have time to rest or when you are ready to sleep, what kind of issues in your family or neighborhood keep you up? OK Question Title * 28. If given the opportunity, would you be willing to serve on a local board or committee that represents and makes decisions for families with low-income? Yes No Name and phone number OK Question Title * 29. Did Tazwood Community Services help you in a timely manner? Yes No Not applicable OK Question Title * 30. The staff at Tazwood Community Services, Inc. treated me/us with respect? Yes No Not applicable OK Question Title * 31. The staff at Tazwood Community Services, Inc. were helpful and friendly? Yes No Not applicable OK Question Title * 32. I got the information and/or services that I needed from Tazwood Community Services, Inc.? Yes No Not applicable OK Question Title * 33. I was informed of other agencies or community services by Tazwood Community Services, Inc. Yes No Not applicable OK Question Title * 34. I would recommend Tazwood Community Services, Inc. to family & friends. Yes No Not applicable OK Question Title * 35. What is the one thing you would change about the services (in any) received from Tazwood Community Services, Inc. OK Question Title * 36. Other comments or concerns? OK DONE