Project 17 Regional Assessment - Community Question Title * 1. The county where I live Allen Anderson Bourbon Chautauqua Cherokee Coffey Crawford Elk Franklin Greenwood Labette Linn Miami Montgomery Neosho Wilson Woodson None of the above Question Title * 2. The county where I work Allen Anderson Bourbon Chautauqua Cherokee Coffey Crawford Elk Franklin Greenwood Labette Linn Miami Montgomery Neosho Wilson Woodson Multiple counties Question Title * 3. I am affiliated with which group (s) listed below citizen-at-large student city government county government institution of higher education unified school district law enforcement chamber of commerce mental health department not-for-profit agency public housing authority health department veteran services social service agency correctional facility community action agency Other (please specify) Question Title * 4. Names and contact information of major opinion leaders in your community Question Title * 5. Names and contact information of entities that should be included in this regional assessment Question Title * 6. Community planning issues: Please rank the following community issues in order of their importance to you. The ranking will be done automatically for you when you make your choice from the drop down menu 1 2 3 4 5 6 7 8 the economy; e.g. growth is too slow, cannot keep pace with cost of living 1 2 3 4 5 6 7 8 crime: e.g. I feel unsafe 1 2 3 4 5 6 7 8 access to legal services 1 2 3 4 5 6 7 8 built environment; e.g. walking/biking trails, indoor and outdoor recreation opportunities 1 2 3 4 5 6 7 8 community engagement in and support of the school district 1 2 3 4 5 6 7 8 infrastructure upgrades; e.g. streets, sewers, water supply 1 2 3 4 5 6 7 8 leadership; e.g. working together to make things better (city, county, school district, chamber of commerce, college, hospital, etc.) 1 2 3 4 5 6 7 8 job growth; e.g. access to high speed internet, skills training for those who need it Question Title * 7. Employment: Please rank the following issues that are barriers to you seeking employment. Your selection will be automatically when you make your choice from the drop down menu. 1 2 3 4 5 6 access to education 1 2 3 4 5 6 cost of education 1 2 3 4 5 6 access to living wage jobs 1 2 3 4 5 6 lack of any employment opportunities 1 2 3 4 5 6 lack of public transportation to and from work 1 2 3 4 5 6 lack of affordable child care Question Title * 8. Are you aware of the employment services provided by Kansas Works? Yes No Question Title * 9. Have you used services offered by Kansas Works? Yes No Question Title * 10. Health: Please rank the following issues as they affect your PERSONAL HEALTH. Your selections will be automatically moved when you make your choice from the drop down menu. 1 2 3 4 5 6 7 8 9 10 11 cost of primary health care 1 2 3 4 5 6 7 8 9 10 11 access to primary health care 1 2 3 4 5 6 7 8 9 10 11 cost of mental health care 1 2 3 4 5 6 7 8 9 10 11 access to mental health care 1 2 3 4 5 6 7 8 9 10 11 access to physical activity 1 2 3 4 5 6 7 8 9 10 11 cost of nutritious food 1 2 3 4 5 6 7 8 9 10 11 access to nutritious food 1 2 3 4 5 6 7 8 9 10 11 affordable housing 1 2 3 4 5 6 7 8 9 10 11 obesity 1 2 3 4 5 6 7 8 9 10 11 substance abuse; e.g. drugs, alcohol 1 2 3 4 5 6 7 8 9 10 11 tobacco and smokeless tobacco use Question Title * 11. Community issues: Rank the following COMMUNITY ISSUES in order of their importance to you. Your choices will automatically move when you select a number from the drop down menu 1 2 3 4 5 6 7 8 9 10 11 cost of primary health care 1 2 3 4 5 6 7 8 9 10 11 access to primary health care 1 2 3 4 5 6 7 8 9 10 11 cost of mental health care 1 2 3 4 5 6 7 8 9 10 11 access to mental health care 1 2 3 4 5 6 7 8 9 10 11 cost of nutritious food 1 2 3 4 5 6 7 8 9 10 11 access to nutritious food 1 2 3 4 5 6 7 8 9 10 11 affordable housing 1 2 3 4 5 6 7 8 9 10 11 obesity 1 2 3 4 5 6 7 8 9 10 11 substance abuse; e.g. drugs, alcohol 1 2 3 4 5 6 7 8 9 10 11 tobacco and smokeless tobacco use 1 2 3 4 5 6 7 8 9 10 11 access to physical activity Question Title * 12. I live at or below the federal poverty level yes no Question Title * 13. Yes, I live in poverty and my choice for the future is to do nothing, I am used to it to do nothing; the problem is caused by the system we live in here in America to do whatever I can with the help I get from social service agencies to seek education to improve my skills so I am more employable to keep working hard and save for the future Question Title * 14. Yes, I live in poverty. Please rank the following challenges you might face if seeking an education. Choices will automatically rank themselves when you make your choice from the drop down menu 1 2 3 4 5 6 7 8 I do not know where to go to seek assistance for education 1 2 3 4 5 6 7 8 I fear the embarrassment that I may face if I seek educational assistance 1 2 3 4 5 6 7 8 I hate attending classes because it is hard for me to sit still, I get bored, I do not like to speak in front of others, etc. 1 2 3 4 5 6 7 8 I do not feel that I am capable of doing better even if I do seek educational assistance 1 2 3 4 5 6 7 8 I do not want to leave my home or hometown and fear that more education will require me to leave to get good employment 1 2 3 4 5 6 7 8 I am too old to try to do better 1 2 3 4 5 6 7 8 I am not too old, but too set in my ways to try to do better 1 2 3 4 5 6 7 8 I do not have anyone in my life who cares about me to help me improve my situation through more education Question Title * 15. Demographic data - age 19 and under 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 85 85 and up Question Title * 16. Demographics: Gender Male Female Question Title * 17. Demographic Data: Ethnicity White/Caucasian African American/Black Asian/Pacific Islander Native American Hispanic or Latino Two or more Races Done