SurveyMonkey Powered Online Survey

The following questions are meant to get a better understanding of the needs of the community. When answering these questions, please consider both your personal needs and the needs of the community in general. Please mark no more than 3 boxes per question. If you only identify 1 or 2 of the items as priorities, then only check that many boxes. If the priority you identify is not on the list please write it below the question with any comments you may have. Thank you for taking the time to complete this survey!

Question Title

* 1. What do you feel are the primary EMPLOYMENT issues in this community (check a maximum of 3 boxes)

Cost of childcare

Not enough good paying jobs with benefits

Unable to find jobs in area

Wages are too low

People lack skills to obtain a job

People lack education to obtain a job

Lack of transportation

Employment income impacts eligibility for services

Alcohol/Drug use

Disability/chronic illness

Employers leaving the area

Other employment issues of concern or comments?

Question Title

* 2. What do you feel are the primary EDUCATION issues in this community (check a maximum of 3 boxes)

Lack of vocational training

Lack of GED/Adult Education Classes

Lack of college education

Lack of dropout prevention for youth

Lack of preschool programming

Lack of transportation (school related)

Lack of childcare (school related)

Cost of tuition

Other education issues of concern or comments?

Question Title

* 3. What do you feel are the primary HOUSING issues in this community (check a maximum of 3 boxes)

High cost of homeownership

High cost associated with moving

Lack of temporary emergency housing (homeless)

Lack of temporary emergency housing (domestic violence)

Lack of affordable rental housing

Housing in poor condition

Utility costs are high

Other housing issues of concern or comments?

Question Title

* 4. What do you feel are the primary NUTRITION issues in this community (check a maximum of 3 boxes)

High cost of healthy foods

Not enough income to cover food costs

Lack of transportation to grocery store/food pantry

Lack of knowledge on healthy food choices

Lack of knowledge on available nutrition programs (WIC, foodstamps, etc)

Food resources not available (senior meals, meals on wheels, food pantry)

Other nutrition issues of concern or comments?

Question Title

* 5. What do you feel are the primary INCOME issues in this community (check a maximum of 3 boxes)

High cost of check cashing/cash advance services

Difficulty with money management

Lack of use of free tax preparation (low-moderate income)

Lack of knowledge about savings

Lack of knowledge about addressing credit issues

Lack of knowledge about possible resources, i.e. food stamps, medical coverage, etc.

Lack of interest in making appropriate use of income

Other income issues of concern or comments?

Question Title

* 6. What do you feel are the primary TRANSPORTATION issues in this community (check a maximum of 3 boxes)

Lack of accessible transportation for non-emergency medical situations

Lack of knowledge on how to buy a vehicle

Cost of owning and operating a vehicle

Lack of credit to buy a vehicle

Cost of gasoline

Lack of assistance in learning to drive/getting a license

Lack of public transportation

Other transportation issues of concern or comments?

Question Title

* 7. What do you feel are the primary HEALTH CARE issues in this community (check a maximum of 3 boxes)

No insurance

Costs too much

No doctors/clinics in town

No transportation to doctor

Doctors will not accept medicaid

Lack of resources for alcohol/drug treatment

Lack of resources for mental health treatment

Other health care issues of concern or comments?

Question Title

* 8. What do you feel are the primary YOUTH issues in this community (check a maximum of 3 boxes)

Teen pregnancy

Gang membership

Dropping out of school

Bullying

Learning disabilities

Emotional or behavioral problems

Weight/eating habits

Not much to do away from school

Lack of role models

Adults not in touch with needs of youth

Stress

Depression

Alcohol/Drug use by youth

Alcohol/Drug use in the family

Lack of opportunities to develop skills needed as adult

Violence

Other youth issues of concern or comments?

Question Title

* 9. Are there unmet needs for childcare services in the community?

Yes

Question Title

* 10. If you answered YES to QUESTION 9, what do you believe are the primary barriers to obtaining child care services? (check a maximum of 3 boxes)

Cost

Location

Time service is available

Quality of providers

Not enough providers

Issues regarding reimbursement

Special needs children

Question Title

* 11. What are the most important unmet CHILDREN'S needs in your community? (check a maximum of 3 boxes)

Unsafe areas to raise children

Childcare is unaffordable

Lack of early child education programs

Lack of after-school programs

Not enough childcare facilities

Not enough safe, suitable forms of recreation

Parents need more knowledge on how to parent

Lack of summer activities for children

Lack of knowledge about proper nutrition in the home

Not enough family support in caring for children

Question Title

* 12. What do you think are the main issues facing FAMILIES in the community? (check a maximum of 3 boxes)

Lack of education

Drug use

Unhealthy lifestyles

Domestic abuse

Child abuse/neglect

Not enough medical coverage

Not enough affordable housing

Make too much to receive public assistance but still need assistance

Lack of support programs

Lack of transportation options

Being a single parent

Not knowing where to go for help

Other (please specify)

Question Title

* 13. What do you think are the main areas that need more attention (check a maximum of 3 boxes)

Employment

Education

Housing

Nutrition

Income

Transportation

Health Care

Childcare

Drug use

Question Title

* 14. Have you had a need go unmet in the last year?

Yes

Question Title

* 15. If you answered YES to QUESTION 14, please check all of your needs that went unmet in the past year.

Not covered by health insurance

Lack of emergency shelter

Lack of access to mental health services

Lack of income for prescription drugs

Alcohol abuse assistance

Drug abuse assistance

Legal assistance

Lack of food

Lack of income for utilities

Losing/lost home

Other (please specify)

Question Title

* 16. If you or someone you know were experiencing one of the following problems, would you know where to get help?

	Yes	No
Inability to pay gas/electric bills	Inability to pay gas/electric bills Yes	Inability to pay gas/electric bills No
Inability to pay water bills	Inability to pay water bills Yes	Inability to pay water bills No
Home in foreclosure	Home in foreclosure Yes	Home in foreclosure No
Homelessness	Homelessness Yes	Homelessness No
Bad credit	Bad credit Yes	Bad credit No
Lack of child care	Lack of child care Yes	Lack of child care No
Home in need of repairs	Home in need of repairs Yes	Home in need of repairs No
Disability resulting in inability to work	Disability resulting in inability to work Yes	Disability resulting in inability to work No
Domestic violence	Domestic violence Yes	Domestic violence No
Unemployment	Unemployment Yes	Unemployment No
Parenting stress	Parenting stress Yes	Parenting stress No
No food	No food Yes	No food No
Poor nutrition and unhealthy lifestyle	Poor nutrition and unhealthy lifestyle Yes	Poor nutrition and unhealthy lifestyle No
Drug addiction	Drug addiction Yes	Drug addiction No
Alcohol addiction	Alcohol addiction Yes	Alcohol addiction No
Stress from providing care to a disabled or ill loved one	Stress from providing care to a disabled or ill loved one Yes	Stress from providing care to a disabled or ill loved one No
Free tax preparation assistance (low and moderate income)	Free tax preparation assistance (low and moderate income) Yes	Free tax preparation assistance (low and moderate income) No
Adult education (GED, etc)	Adult education (GED, etc) Yes	Adult education (GED, etc) No

The following questions ask some personal information. We only ask these questions to make sure we get surveys from different demographic groups within the community. Your name is not on the survey, so all of your personal information will remain confidential.

Question Title

* 17. Which county do you live in?

Carbon

Emery

Grand

San Juan

Question Title

* 18. Please indicate your age bracket:

17 or younger

18-23

24-44

45-54

55-69

70+

Question Title

* 19. Please indicate your gender:

Male

Female

Question Title

* 20. Please indicate ethnicity:

Asian

Black/African American

Hispanic/Latino

American Indian/Alaskan Native

White

Pacific Islander

Other (please specify)

Question Title

* 21. Please indicate household type:

Two Parent

Single Parent – Male

Single Parent – Female

Grandparent raising grandchildren

Couple – No children at home

Single Person

Step Family

Other (please specify)

Question Title

* 22. How many people live in your household?

Self

Question Title

* 23. Please indicate your TOTAL household income:

0-$10,000

$10,001- $20,000

$20,001 - $30,000

$30,001 - $40,000

$40,001 - $50,000

$50,001 and over

Question Title

* 24. Please indicate your TOTAL household income – 3 YEARS AGO:

0-$10,000

$10,001- $20,000

$20,001 - $30,000

$30,001 - $40,000

$40,001 - $50,000

$50,001 and over

Question Title

* 25. Highest level of education in your household.

Elementary School

Middle/Junior High School

High School/GED

Trade School

Some College

Associates Degree

Bachelors Degree

Graduate/Professional Degree