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Hampton Roads Community Action Program - Community Assessment Survey
Please answer the following questions to help us assess conditions in the community.
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What is the zip code of your home address?
*
Your answer
Check any of the following that would be beneficial for you or your family:
Check All That Apply
Employment
Housing
Education
Childcare
Clothing
Food
Utilities
Job Transportation
Medical Transportation
Disability Assistance
Housing Loans
Housing Repairs
Elder Care
Medical Healthcare
Dental Healthcare
Vision Healthcare
Prescriptions
Mental Healthcare
Hospice
Legal Services
Counseling
Domestic Violence Services
Income Tax Preparation
Senior Service
None of the Above
Please list any additional programs/services you or your family would find beneficial that were not listed above:
Your answer
Are you a parent, or the primary caregiver of a child or children under the age of 18?
*
Yes
No
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