AJFC Community Needs Assessment

The following questionnaire will only take a few minutes to complete. Your input will assist in our work to help individuals and families, assess community needs, identify gaps in services, and eliminate barriers to services. All information will be kept confidential and your name is not required on the questionnaire. 

Thank You For Your Time!

Every Question is to be completed or this questionnaire will be removed from the resulting pool.  Please check the appropriate answer for each question.

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What is your role in the community? (Please select the best choice which fits your role when completing the survey)


Please make a selection(s) below.  

*
Required
In which county do you live or represent?
Please make a selection(s) below.  
*
In which city do you live?
Please make a selection(s) below.  
*
What is your gender? *
What is your age? *
What is your race? *
What is your ethnicity? *
What is your educational level? *
The amount that best represents your annual household income
*

What best describes your household?

*

Including yourself, how many people live in your home?

*
Are you disabled? *
What is your Military status?
Clear selection
Do you have health insurance? *

As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey.  

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Education

*
Required

As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey. 

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Employment

*
Required

As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey.

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Housing

*
Required

As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey. 

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Health

*
Required
As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey.

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Early Child Care and Education
*
Required
As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey. 

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Income and Asset Building
*
Required
As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey. 

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Civic Engagement
*
Required
As part of the local Community Action Agency ongoing Community Needs Assessment, we are asking that you assist us by completing the following survey. 

The results of the survey assist in targeting funding toward the greatest community needs.

Please make a selection(s) below.  

Support Services
*
Required

Based on the prior selected items, please mark the top three (3) main service categories you feel your community needs most.

Please make a selection(s) below.  

*
Required
Who is your Case Worker/Manager?
Please provide your email address to join our mailing list.
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