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2022 Community Needs Survey (English)

You recently received services from Community Action Agency. Please take a moment to share your thoughts with us. This will help us better serve individuals and families who are seeking assistance.

Please answer the following questions by selecting what you feel is the most accurate answer.

* A. Lack of Affordable Housing in this community is a problem because: (Choose 1)
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* B. Unemployment is a problem in this community because: (Choose 1)
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* C. High heating and utility costs are a problem in this community because: (Choose 1)
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* D. In your view of the following, which are most important to having a good community (Choose 3)
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* E. Transportation is a problem because: (Choose all that apply)
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* F. Please choose three (3) of the following areas that are most important to you right now:
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G. If you chose health insurance in Question F above, who in your household currently has health insurance:
H. If you / your children have health insurance, what type of insurance do you have? (Choose all that apply)
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* I. Are you concerned about: (Choose all that apply)
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* J. Which of the following are missing from your neighborhood? (Choose all that apply)
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We would like to know some general information about you that will help us use the results of this survey. Your identity and answers are confidential and we are not asking for your name.

1. Culture / Ethnicity: (Choose all that apply)
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* 2. How do you identify:
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Comments:
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* 3. Age Range: (Choose one)
4. Marital Status: (Choose one)
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5. Education: (Last grade completed)
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5 (a). Have you received a:
* 6. City / County of Residence: (Choose only one)
* 7. I came to CAA for: (Choose all that apply)
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* 8. Are you a:
8 (a). If you are an ongoing client, how many years?
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* 9. Source of Income: (If you have more than one source of income, choose all that apply)
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10. Gross Household Income Per Month: (Before taxes are taken out)
11. Do you have a: (Choose all that apply)
12. If you have a checking and/or savings account, is the total of the account balance(s):
13. Have you closed a bank account in the past year?
14. Do you have a: (Choose all that apply)
15. In the past year, have you used a: (Choose all that apply)
16. If you are not yet retired, have you put money into a retirement plan through IRA, 401(k), or work pension fund in the last 6 months?
17. Which do you have at home: (Choose all that apply)
* 18. Are you a:
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18 (a). How much is your monthly rent or mortgage payment?
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18 (b). Is this payment subsidized?
19. How many times have you moved in the past year?
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20. Do you receive food stamps?
21. Where do you usually get groceries? (Choose all that apply)
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22. In general, do you feel that you are:
Comment:
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23. Is there something you want to do or are determined to do within the next few years?
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Thank you for participating in this survey. We appreciate you taking the time to share your thoughts, experiences, and opinions!