1. Perceived Community Needs

Thank you for providing input on the needs of our community.  The data collected through this survey will be used to inform community leaders about issues facing your County and also be used to evaluate existing and future programs provided to your community from non-profit and public agencies in your area.

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* 1. Do you feel safe in your community?

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* 2. What is your current housing situation? (check all that apply)

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* 3. If you rent, has your rent increased within the past 2 years?

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* 4. What do you feel are the primary EMPLOYMENT issues in this community? (check a maximum of 3 boxes)

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* 5. What do you feel are the primary EDUCATION issues in this community? (check a maximum of 3 boxes)

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* 6. What do you feel are the primary HOUSING issues in this community? (check a maximum of 3 boxes)

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* 7. What do you feel are the primary NUTRITION issues in this community? (check a maximum of 3 boxes)

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* 8. What do you feel are the primary INCOME issues in this community? (check a maximum of 3 boxes)

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* 9. Do your household expenses exceed your household income?

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* 10. What do you feel are the primary TRANSPORTATION issues in this community? (check a maximum of 3 boxes)

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* 11. What do you feel are the primary HEALTH CARE issues in this community? (check a maximum of 3 boxes)

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* 12. Does everyone in your household have health insurance?

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* 13. What do you feel are the primary YOUTH (age 12-18) issues in this community? (check a maximum of 3 boxes)

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* 14. What are the most important unmet CHILDREN'S needs in your community? (check a maximum of 3 boxes)

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* 15. What do you think are the main issues facing FAMILIES in the community? (check a maximum of 3 boxes)

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* 16. Does your household have: (check all that apply)

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* 17. Which of the following areas do you feel need more attention in the community? (check a maximum of 3 boxes)

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* 18. What do you believe are the main factors leading to substance abuse in the community? Please check all that apply.

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* 19. Have you had any unmet needs listed below in the past year. (check all that apply)

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* 20. If you or someone you know were experiencing one of the following problems, would you know where to get help?

  Yes No Maybe
Inability to pay utility bills
Home in foreclosure
Homelessness
Bad credit
Lack of child care
Home in need of repairs
Disability resulting in inability to work
Domestic violence
Unemployment
Parenting stress
No food
Poor nutrition and unhealthy lifestyle
Drug addiction
Alcohol addiction
Stress from providing care to a disabled or ill loved one
Free tax preparation assistance (low and moderate income)
Adult education (GED, etc)

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* 21. Where do you hear how to contact these agencies?

The following questions ask some personal information. We only ask these questions to make sure we get surveys from different demographic groups within the community. Your name is not on the survey, so all of your personal information will remain confidential.

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* 22. Which county do you live in?

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* 23. Please enter your zip code:

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* 24. Please indicate your age bracket:

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* 25. Please indicate your gender:

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* 26. Please indicate your ethnicity:

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* 27. Please indicate race:

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* 28. Please indicate your current household type:

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* 29. How many people live in your household?

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* 30. Please indicate your TOTAL household income:

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* 31. Please indicate your source(s) of income: (please check all that apply)

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* 32. Please indicate your highest level of education