Community Needs Survey Question Title * 1. In what ZIP code is your home located? (enter 5-digit ZIP code) Question Title * 2. How old are you Question Title * 3. What is your gender? Male Female Question Title * 4. Which word most accurately portrays your race Black/African American White American Indian/Alaskan Native Asian Other Question Title * 5. What your highest level of education less than 9th grade Some high school High school graduate or GED Some college, no degree Associates Degree Bachelors Degree Graduate Degree Question Title * 6. What is your employment status? Full time Part time Seasonal Not working, retired Not working, unemployed Question Title * 7. In your community, affordable transportation is: Not Available Available but inadequate Sufficient Unsure Question Title * 8. In your community, affordable housing is: Not Available Available but Inadequate Sufficient Unsure Question Title * 9. In your community, affordable childcare is: Not available Available but Inadequate Sufficient Unsure Question Title * 10. In your community, access to mental health and addiction support services is: Not available Available but Inadequate Sufficient Unsure Question Title * 11. In your community, access to affordable health care is: Not available Available but I cannot access it Available Unsure Question Title * 12. In your community, access to Adult Education is: Not available Available but I cannot access it Available Unsure Question Title * 13. How many adults living in your household are currently employed? Question Title * 14. Opportunities for "living wage" employment in your area are: Excellent Good Adequate Inadequate Question Title * 15. Opportunities to access Job training programs are: Excellent Good Adequate Inadequate Unsure Question Title * 16. In the past 12 months did you receive any government assistance? (SNAP, TANF, SSI etc) Yes No Question Title * 17. Are you living paycheck to paycheck? Yes No Question Title * 18. At any time during the past year did you have trouble putting food on the table? Yes No Question Title * 19. Over the past year, have you received any services from BCAC? Yes No Question Title * 20. Do you have any other comments, questions, or concerns? What is your zip code? Done
