Community Needs Questionnaire
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Are you a Potter County resident? *
What is your age? *
What is your gender? *
Which city do you live in? *
Average annual household? *
How many live in your household? *
What community service(s) do you do you typically use?
Which community services are lacking in the area?
Have you ever experienced homelessness or been at risk of being homeless?
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Have you struggled to pay rent or an utility bill in the past?
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Have you utilized any of the following for assistance with rent and/or utilities?
When looking for housing, what sources do you use?
Do you have any suggestions to improve the services available for Potter County residents? Any other services you would like to see? *
Would you like to be contacted with available resources that may be beneficial to you? If so, please provide you name with an email or phone number. *
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