1. Telamon Corporation: Community Needs Assessment - West Virginia 2015 5% of survey complete. Sponsored by Telamon Corporation a West Virginia Community Action Agency Question Title * 1. What county do you live in? Berkeley Jefferson Other Other (please specify) Question Title * 2. Type of current residence? Rental - subsidized Rental - unsubsidized Own home Home with mortgage Living with family / friends Shelter Homeless Other (please specify) Question Title * 3. Household Information How many people live in your household? How many are under the age of 18? How many are over the age 65? How many are veterans? How many are disabled? Question Title * 4. What is your age? 18-24 25-40 41-64 65+ Question Title * 5. What is you gender? Female Male Transgender Male to Female Transgender Female to Male Question Title * 6. What is your marital status? Single Married Divorced Separated Widowed Partner Question Title * 7. What is your household type? Single person Single parent - female Single parent - male 2 adults - with children 2 adults - without children 2 parents - living with children Grandparents - raising grandchildren Question Title * 8. What is your race? American Indian or Alaska Native Asian Bi-racial or Multi-racial Black/African American White/Caucasian Middle Eastern Native Hawaiian or Pacific Islander Other (please specify) Question Title * 9. What is your Ethnicity? Hispanic/Latino Non-Hispanic/Non-Latino Question Title * 10. What is your monthly household income? No income Less than $750 $751-$1,000 $1,001 - $2,000 $2,001+ I don't know how much my parents/guardians make Question Title * 11. What is the highest level of education in your household? Elementary Middle/Junior High School High School/GED Some College Trade School Associates Degree Bachelors Degree Graduate/Professional Degree Question Title * 12. Sources of Household Income (Check all that apply) Full time (Wages or Salary) Part time (Wages or Salary) With employment benefits Contract work Pension or Retirement benefit Social Security Workers Compensation or other disability Unemployment Odd Jobs TANF Farming I do not work or receive any benefits Self-employed Question Title * 13. Have you ever used a service provided by Telamon Corporation? Yes No If so, which service (please specify) Next