Online Survey #1

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* 1. How would you describe your relationship to the Eastland area? Select all that apply.

I live in the Eastland area

I work in the Eastland area

I worship in the Eastland area

I learn in the Eastland area

I visit the Eastland area

I own property or a business in the Eastland area

I live in an adjacent neighborhood or jurisdiction outside of the Eastland area

Other (please specify)

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* 2. Please rate the frequency with which you can meet the following daily needs without having to leave the Eastland area.

	Always	Very Often	Sometimes	Rarely	Never	N/A
Go grocery shopping / purchase food	Go grocery shopping / purchase food Always	Go grocery shopping / purchase food Very Often	Go grocery shopping / purchase food Sometimes	Go grocery shopping / purchase food Rarely	Go grocery shopping / purchase food Never	Go grocery shopping / purchase food N/A
Access medical care	Access medical care Always	Access medical care Very Often	Access medical care Sometimes	Access medical care Rarely	Access medical care Never	Access medical care N/A
Access childcare	Access childcare Always	Access childcare Very Often	Access childcare Sometimes	Access childcare Rarely	Access childcare Never	Access childcare N/A
Complete other caretaking tasks	Complete other caretaking tasks Always	Complete other caretaking tasks Very Often	Complete other caretaking tasks Sometimes	Complete other caretaking tasks Rarely	Complete other caretaking tasks Never	Complete other caretaking tasks N/A
Access banking / financial institutions	Access banking / financial institutions Always	Access banking / financial institutions Very Often	Access banking / financial institutions Sometimes	Access banking / financial institutions Rarely	Access banking / financial institutions Never	Access banking / financial institutions N/A
Send my children or children I care for to school	Send my children or children I care for to school Always	Send my children or children I care for to school Very Often	Send my children or children I care for to school Sometimes	Send my children or children I care for to school Rarely	Send my children or children I care for to school Never	Send my children or children I care for to school N/A
Purchase non-food household necessities	Purchase non-food household necessities Always	Purchase non-food household necessities Very Often	Purchase non-food household necessities Sometimes	Purchase non-food household necessities Rarely	Purchase non-food household necessities Never	Purchase non-food household necessities N/A
Spend time outdoors or at a park	Spend time outdoors or at a park Always	Spend time outdoors or at a park Very Often	Spend time outdoors or at a park Sometimes	Spend time outdoors or at a park Rarely	Spend time outdoors or at a park Never	Spend time outdoors or at a park N/A
Participate in recreation or sports	Participate in recreation or sports Always	Participate in recreation or sports Very Often	Participate in recreation or sports Sometimes	Participate in recreation or sports Rarely	Participate in recreation or sports Never	Participate in recreation or sports N/A
Access a computer / Wi-Fi	Access a computer / Wi-Fi Always	Access a computer / Wi-Fi Very Often	Access a computer / Wi-Fi Sometimes	Access a computer / Wi-Fi Rarely	Access a computer / Wi-Fi Never	Access a computer / Wi-Fi N/A

Other (please specify)

Question Title

* 3. If you are rarely or never able to meet the following needs within the Eastland area, where in Columbus or Central Ohio do you go instead?

Go grocery shopping / purchase food

Access medical care

Access childcare

Complete other caretaking tasks

Access banking / financial institutions

Send my children or children I care for to school

Purchase non-food household necessities

Spend time outdoors or at a park

Participate in recreation or sports

Access a computer / Wi-Fi

Other

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* 4. If you could improve the Eastland area, what would you like to see in the community?

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* 5. Is there anything else you would like to share with us as we begin this planning work together?

The following demographic questions are optional but will help us to know who we are reaching in the engagement process.

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* 6. In what ZIP code do you live?

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* 7. What is your age?

Under 18

19-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

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* 8. How would you describe your gender?

Woman

Man

Non-binary

Prefer not to answer

Prefer to self-describe:

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* 9. Which of the following best describes your race / ethnicity? Select all that apply.

Indigenous, American Indian or Alaska Native

Black or African American

East Asian

Hispanic / Latino

Native Hawaiian or Pacific Islander

Middle Eastern or North African

South Asian

Southeast Asian

White

Prefer not to answer

Other (please specify)

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* 10. Including yourself, how many people are there in your household?

5 or more

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* 11. How would you describe your household? Select all that apply.

I live with a roommate(s) who is unrelated to me

I live with my spouse / partner

I have a child / children under 5 years old living in my home

I have a child / children 6 - 12 years old living in my home

I have a child / children 13 - 18 years old living in my home

My parent(s) or another adult relative lives in my home

Other (please specify)

Question Title

* 12. What is your approximate annual household income?

Under $30,000

$30,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $149,999

$150,000 or more

Prefer not to answer

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* 13. If you would like to receive email updates, please leave your contact information below.

Name

Email Address

Phone Number