Horizons Mental Health Center's Child Advocacy Center (CAC) is conducting a community assessment on individual's living in the community and surrounding areas the CAC serves. All information obtained in this survey will be kept confidential.

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* 1. County of Residence

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* 2. Race/Ethnicity

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* 3. What is the primary language spoken in the home?

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* 4. Age

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* 5. What is your sex assigned at birth?

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* 6. What gender do you identify with?

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* 7. What is your sexual orientation?

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* 8. What is your approximate average household income?

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* 9. Do you identify with any of the following religions? (Please select all that apply.)

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* 10. In general how would you rate the overall health your county

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* 11. Are you aware of efforts in your community to prevent child abuse and maltreatment?

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* 12. Has your child received school based child abuse prevention?

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* 13. In your opinion, is your household doing well? (ex: succeeding, thriving)

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* 14. What is the primary mode of transportation for the household?

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* 15. Is your household able to receive/get mental health and primary health care when needed?

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* 16. Does anyone in this household struggle with their mental health?

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* 17. Do all members of the household feel safe in their...

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* 18. Has anyone in your household been a victim of crime?

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* 19. In your opinion, what is the biggest concern of your community?

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* 20. What other concerns/needs do you feel your community needs to address

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