Resource Survey
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1.
Would you like assistance with job search or employment placement?
(Required.)
Yes
No
What is your field of interest?
*
2.
Are you interested in enrolling in career training classes?
(Required.)
Yes
No
*
3.
Are you over 65 and need assistance with daily living activities such as meals, laundry and housekeeping?
(Required.)
Yes
No
*
4.
Do you have anyone in your household between the ages of 16 and 24 who dropped out of high school at any time?
(Required.)
Yes
No
*
5.
If you are under the age of 64 and receiving SSI or SSDI benefits, are you interested in going to work?
(Required.)
NO, I am not receiving SSI/SSDI benefits
YES, I am receiving SSI/SSDI benefits and would like to go to work
NO, I am not interested in going to work while receiving my SSI/SSDI benefits
*
6.
If you have school-age children in your household, what school(s) do they attend?
(Required.)
*
7.
Do you have children in your household that are under the age of 5?
(Required.)
Yes
No
*
8.
Are you interested in owning your own home?
(Required.)
Yes
No
*
9.
Is anyone in your household receiving support services such as tutoring, mentoring, counseling, anger management, trauma support services, etc.?
(Required.)
NO, no one in my household is receiving support services
NO, no one in my household is receiving support services, but I am interested in discussing support service needs
YES, either myself and/or a member of my household is receiving support services. (Please list them below.)
Other (please specify)
*
10.
If you are interested in receiving updates from the Office of Resident Services via email or text message, please include your email address and cell phone number in the box below.
(Required.)
*
11.
Do you have internet access in your home?
(Required.)
Yes
No
*
12.
Do you have a working computer device in your home (such as desktop computer, laptop or tablet)?
(Required.)
Yes
No
*
13.
Would you be interested in computer literacy classes?
(Required.)
Yes
No
*
14.
Please select your age group
(Required.)
18-26
27-34
35-54
55-61
62 or older
*
15.
Tell us where you live.
(Required.)
Brooklyn
Cherry Hill
Douglass
Dukeland
Gilmor
HCVP (Section 8)
Latrobe
McCulloh
O'Donnell Heights
Poe
Rosemont
Scattered Sites (Public Housing)
Westport/Mt. Winans
16.
What is your address?
Current Progress,
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