LHA Resident Opportunity & Self-Sufficiency Community Needs Assessment Survey
Household Information
1.
Are you an adult 18 or over?
Yes
No
2.
Are you the head of household?
Yes
No
3.
Does anyone in your household have physical or mental disability?
Yes
No
4.
How would you rate the following issues for your household?
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Availability of job training opportunities
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Availability of jobs for adults
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Availability of jobs for youth
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Education
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Availability of child care services
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Lack of computer/digital literacy
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Lack of affordable Internet service
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Cost of living
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Income/wages
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Debt
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Financial security
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Availability of financial services
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Availability of financial counseling
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Elderly living assistance (62+)
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Physical health
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Mental health
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Seeking employment with a criminal record
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Obtaining a degree/diploma with a criminal record
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Availability of substance abuse services
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
Need for substance abuse treatment
Serious Problem
Moderate Problem
Not a Problem
Does not apply to my household
5.
What are the things that make it difficult for you or other adults in your household to find and/or keep work? (check all that apply)
Nothing
Need affordable childcare
Caring for a family member who is sick or disabled
Do not speak English well
Need computer training
Lack of transportation
Need Internet access
Need job experience
Need job training
No job opportunities
Do not have a high school diploma or GED
Do not have a college degree
Disability
Criminal record
Child Care
Transportation
Other -specify
Other (please specify)
6.
Do you or any others in your household have interest in the following? (check all that apply)
GED/Adult Education
Vocational Training
Increasing income
Getting a job
Getting a better job
Computer training
Saving money
Eliminating debt
2-year college
4-year college
Trade school
Other (please specify)
7.
Do you or another adult in your household have difficulty with any of the following? (check all that apply)
Reading
Math
Writing
Speaking English
Reading English
Writing English
Using a computer
Other
8.
What are the primary health care needs of your household? (check all that apply)
Primary health care
Pediatric (child) care
Prenatal (pregnancy) care
Dental care
Health care education/prevention
Nutrition and exercise programs
Services to help alleviate stress, anxiety, depression
Assistance with daily living for elderly/disable residents
Health screening services
Substance abuse treatment
Stop smoking programs
Stop drinking programs
Transportation to heath care services
Don't know
None
Other (please specify)
9.
What is your gender? (choose one)
Female
Male
Other
10.
What is your current age?
Under 18
18-24
25-34
35-44
45-54
55-65
65 or older