Bodaway Gap Chapter - 2021 Community Needs Assessment
By completing this survey, you will help towards our research and understanding of families' resources and needs. This survey entails questions about education, employment, housing, health care and other basics needs. This will take approximately 15 minutes - more or less. The benefit of this survey is that you will be helping the Bodaway Gap Chapter - Navajo Nation in better understand our community needs and ways to move forward in addressing services that are needed most. These is no risk for your participation and no penalty. All information will be kept confidential. Thank you. (Data collection is a reliable source when applying for funds.)
Today's Date *
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What is your age? (Must 18 years and older to complete the survey.) *
Last Name and First Name: *
Physical Address: *
Optional: Email address *
Are you a registered voter with Bodaway Gap Chapter? *
Which of the following best presents your racial or ethnic heritage? *
What language do you speak at home? *
Do you have a complete Homesite Lease? *
Do you need a Archeological Survey for your Homesite Lease? *
How far did you go in school? *
Are you able to work? *
What is your employment status? *
Do you have reliable telephone or Cell phone service? *
Do you have access to the internet? *
Where do you usually use the internet? *
What is your housing status? *
Do you have any of the following housing related needs? (Check all that apply) *
Required
How many people live where you stay? *
Required
Are you in need of any of the items? *
Required
Do you have electricity? (Power) *
If you do not have electricity or power, how far is the nearest power line to your home? *
If you do not have electricity or power, do you have complete drywalls for installation? *
Do you use Solar Power? *
Do you have running water in your home? *
If you do not have running water, how far is the nearest water line? *
Do you have a installed septic tank? *
Do you need a Septic Tank? *
Do you need a Septic Tank Flush?
Clear selection
Do, you or someone in your home have special needs? *
Where do you usually get your food? (Nearest town) *
Do you need information on food nutrition? *
Do you need to know how to store food so it will last longer? *
Are you a US Veteran? *
If you are a US Veteran, are you receiving benefits? *
If you are not receiving veteran's benefits, do you need help getting them? *
Do you have transportation? *
In the last five (5) years, how many Chapter Meetings have you participated in? *
In the last five (5) years, how many Planning Meetings have you participated in? *
Would you like to see Greenhouse Development in your community? *
Would you like to see recreational development? (Check all that apply) *
Required
Do you feel that CLUP C - Community Land Use Planning - Committee is important? *
Which "chapter meeting" arrangement meets your needs best? *
Do you need Personal Protective Equipment (PPE)? *
Were you affected by the COVID 19 directly? *
Did you lose a family member to COVID 19? *
Are you in favor of a community cemetery development? *
Do you have a Navajo Nation Grazing Permit? *
Are you experiencing, livestock issues?
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What is your Zip Code? *
What resource, do you need the most? *
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