Lake Cumberland Community Action Agency, Inc. Survey

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* 1. Are you Male or Female?

Male

Female

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* 2. The total number of people living in your household?

9 or more

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* 3. The number of children under the age of 18 living in your home?

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* 4. The number of persons in your home that are age 65 and over?

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* 5. Your age category?

0-16

17-24

25-34

35-44

45-54

55-64

65 or more

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* 6. Your race or ethnic background?

Black (not Hispanic)

White (not Hispanic)

Hispanic origin

Native American

Asian origin

Other (please specify)

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* 7. Your household income range?

$0-$10,000

$10,001-$16,000

$16,001- or more

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* 8. The County in which you live?

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* 9. What do you feel are the major needs of your Community? (Select Two)

How to budget the money that is received (income management).

Jobs in the community that pay a living wage (employment).

Decent, affordable housing for families to rent or buy.

Sufficient education.

Awareness of programs and services available to improve the quality of life.

Our community needs more youth programs.

Families need more guidance on how to become self-sufficient.

Assistance with health concerns.

Emergency assistance

Nutritional workshops, meal preparation.

People are not involved enough to make our Community a better place to live (linkages).

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* 10. What services or programs do you feel your community needs? (Select Two)

Adult education programs

Budget training (income management)

Emergency financial assistance programs for rent/mortgage/utilities

Low rent housing programs

Volunteer programs (Linkages)

Job training programs (Employment)

Nutrition programs/food banks

Case managers that explain services available in my community

Programs that help families become self sufficient

Opportunities for the Youth in our community

Programs that assist families with obtaining the health care they need

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* 11. What makes it hard for you or your family members to get and keep a job? (Select Two)

No training or job skills

Lack of transportation

Lack of motivation

Health problems

Child care

Discrimination

Other (please specify)

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* 12. What do teenagers in your area need most to prepare for the future? (Select Two)

Self-esteem

Money for College

Good grades in school

Job training/work experience

Encouragement/support

Other (please specify)

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* 13. Do you own or rent your home?

I rent my home

I own my home

I rent my home with government assistance (Section 8 or public housing)

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* 14. Do you have any suggestions to improve your Community Action Programs?

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* 15. Health?

Do you have insurance?

Do you have a primary care physician?

Do you have a family dentist?

Does your family receive regular dental check-ups?

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* 16. Education - What is the level of Education of parent of guardian?

Grade School

High School Diploma

GED

Two year College Degree

Four year College Degree

Currently attending college or trade school

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* 17. Employment - Are you currently employed? Or underemployed?

Full-time

Part-time

Currently unemployed

(If you are currently unemployed). How Long?

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* 18. Is child / day care readily available and accessible to you?

Yes

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* 19. Do you receive child care subsidy?

Yes

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* 20. What are the top three issues currently effecting your family?

Food

Education

Nutrition

Clothing

Employment

Unemployment

Housing

Utility Payments

Transportation

Health Care

Mental Health

Affordable Child Care

Dental Care

Vision Care

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* 21. Is your child enrolled in Head Start?

Yes

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* 22. Have you had any other children attend Head Start?

Yes

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* 23. Were you a Head Start student?

Yes

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* 24. If you were a Head Start Student do you have a College Degree?

Yes

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* 25. How many years have you been involved in the Head Start Program?

I have not been involved.

List the number of years.

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* 26. Are you a grandparent raising a grandchild?

Yes

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* 27. Do you participate in any leadership activities or organizations at the community, state or other level?

Yes