Resident Survey Question Title * 1. At the present time, how easy is it for you to meet your basic needs and the needs of your family, given your monthly income? (check one) Difficult to Meet Our Needs Somewhat Difficult to Meet Our Needs Somewhat Easy to Meet Our Needs Easy to Meet Our Needs Difficult to Meet Our Needs Somewhat Difficult to Meet Our Needs Somewhat Easy to Meet Our Needs Easy to Meet Our Needs Question Title * 2. How connected do you feel to your neighbors? (check one) Not at All A Little Somewhat A Lot Not at All A Little Somewhat A Lot Question Title * 3. Overall, how would you rate your physical health? Poor Fair Good Excellent Poor Fair Good Excellent Question Title * 4. Overall, how would you rate your mental health? Poor Fair Good Excellent Poor Fair Good Excellent Question Title * 5. Imagine a ladder with steps numbered from zero at the bottom to ten at the top. The top of the ladder (10) represents the best possible life for you and the bottom of the ladder (1) represents your worst possible life.On which step of the ladder would you say you personally feel you stand at this time? Bottom Step (1) 2 3 4 5 6 7 8 9 Top Step (10) Bottom Step (1) 2 3 4 5 6 7 8 9 Top Step (10) Question Title * 6. On which step do you think you will stand about five years from now? Bottom Step (1) 2 3 4 5 6 7 8 9 Top Step (10) Bottom Step (1) 2 3 4 5 6 7 8 9 Top Step (10) Question Title * 7. How easy it is to access the services and supports you need in Eaton County? (check one) Difficult to Access Services Somewhat Difficult to Access Services Somewhat Easy to Access Services Easy to Access Services Difficult to Access Services Somewhat Difficult to Access Services Somewhat Easy to Access Services Easy to Access Services Question Title * 8. How easy is it for you to access affordable housing in Eaton County? (check one) Difficult Somewhat Difficult Somewhat Easy Easy Difficult Somewhat Difficult Somewhat Easy Easy Question Title * 9. Have you ever called 211? Yes No Question Title * 10. IF YES, when you called 211, what happened? (check one) I couldn't find a resource that met my needs The resource I was referred to did not answer or return my call I did not qualify for the resource I was referred to I found a resource and my needs were met Question Title * 11. What are the barriers or challenges you experience when trying to access the services and supports you need in Eaton County? (check all that apply) No programs that meet my needs I don’t qualify for the services I need I could not afford the services I qualified for Not enough providers Limited office hours Long waiting list Transportation Technology barriers The system’s too complicated Feeling of safety / acceptance for seeking services Other (please specify) Question Title * 12. How much do you trust local organizations to understand and support your goals and desires? (check one) Not at All A Little Somewhat A Lot Not at All A Little Somewhat A Lot Question Title * 13. To what extent are there opportunities in this county for you to provide input or share your ideas? (check one) There are No Opportunities There are Some Opportunities There are Many Opportunities There are Always Opportunities There are No Opportunities There are Some Opportunities There are Many Opportunities There are Always Opportunities Question Title * 14. Would you like to be more involved in opportunities to provide input or share your ideas? Yes Maybe No Question Title * 15. Are people looked down upon in your community for seeking services and supports from local organizations? (check one) A Lot Somewhat A Little Never A Lot Somewhat A Little Never Question Title * 16. Overall, from 1 being horrible to 10 being terrific, how would you rate living in Eaton County? Horrible (1) 2 3 4 5 6 7 8 9 Terrific (10) Horrible (1) 2 3 4 5 6 7 8 9 Terrific (10) Question Title * 17. How hopeful do you feel about your future? Not at All Somewhat A Little A Lot Not at All Somewhat A Little A Lot Question Title * 18. What is your greatest need or concern today? (check one) Lack of affordable healthy food Lack of affordable, safe housing Lack of transportation Unemployment Too little employment Access to affordable health care Access to affordable mental health care Loneliness Child care Lack of physical activity Other (please specify) Question Title * 19. What are your goals and dreams for yourself or your family? Question Title * 20. What can your community do to help you achieve those goals and dreams? Next
