Resident Opportunity and Self-Sufficiency Services Survey

Fayette County Community Action Agency, Inc. would like to thank you for taking the time to complete this survey. Please select ALL answers that pertain to you. If none pertain, please select none or no response.

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* 1. Please name the site where you currently live.

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* 2. Are you the head of household?

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* 3. Does anyone in your household have a mental or physical disability?

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* 4. Are you an adult 18 years or older?

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* 5. 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
Availability of jobs for adults
Availability of jobs for youth
Education
Availability of affordable, reliable child-care services
Lack of computer/ digital literacy
Lack of affordable Internet service
Cost of living
Income/ wages
Debt
Financial security
Availability of financial services
Availability of financial counseling
Elderly living assistance (62+)
Physical health
Mental Health
Seeking employment with a criminal record
Obtaining a degree/ diploma with a criminal record
Availability of substance use services
Need for substance use treatment

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* 6. 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)

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* 7. Do you or others in your household have interest in the following? (check all that apply)

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* 8. Do you or another adult in your household have difficulty with any of the following? (check all that apply)

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* 9. What are the primary health care needs of your household? (check all that apply)

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* 10. What is your gender? (check one)

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* 11. What is your age range? (check range)

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