JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Community Needs Survey
For people living in West Virginia and the bordering counties of KY, OH, PA, VA, and MD
Sign in to Google
to save your progress.
Learn more
* Indicates required question
In which state do you reside? (This survey is for people in WV and the surrounding states within 30 min of the WV border)
*
West Virginia
Pennsylvania
Virginia
Ohio
Kentucky
Maryland
What is your gender?
*
Male
Female
Other:
Are you currently employed?
Yes
No (Recently Unemployed: March 2020 or later)
No (unemployed before March 2020)
N/A (retired, unable to work)
Other:
Clear selection
If not employed, would you be willing to work during the COVID-19 crisis?
Yes
No
Maybe, depending on the safety precautions a company takes
Clear selection
How have your work hours changed due to COVID-19?
No Change
Decreased Hours
Increased Hours
Furloughed
Laid Off
Terminated/Fired
Working from home or remote work
N/A
Other:
Clear selection
What is your primary concern AT THIS TIME related to COVID-19?
Housing/Utilities
Food/Nutrition
Health/Safety
Employment/Unemployment
Childcare/Eldercare
Education
Mental Health
Substance Abuse/Recovery/Addiction
Nothing, I have no concerns related to the COVID-19 crisis
Other:
Clear selection
What is your primary concern ONCE THE PANDEMIC ENDS for you or your family?
Housing/Utilities
Food/Nutrition
Health/Safety
Employment/Unemployment
Childcare
Education
Mental Health
Substance Abuse/Addiction/Recovery
Nothing, I have no concerns related to the COVID-19 crisis
Other:
Clear selection
Do you feel you could benefit from enrolling in free career training during the COVID-19 crisis?
Yes
No
Clear selection
Would you be more likely to enroll in free career training during the COVID-19 crisis if it was online only?
Yes
No
Clear selection
Do you currently have access to reliable internet and a computer?
*
Yes
No
Sometimes
Do you feel your computer skills are good enough for you to attend online training?
Yes
No
Clear selection
What do you feel is holding you back from achieving your career or financial goals?
Your answer
How many hours per week can you dedicate to online career training?
0
1
2
3
4
5
6+
Clear selection
What length of online class would you be interested in (Check all that apply)
One time class
One week
One Month
More than one month
What time of day would you be available to attend online training? (Check all that apply)
morning
mid-day
afternoon
evening
night
any time
What type of online class would interest you? (Check all that apply)
Resume Writing
Writing Cover Letters
Goal Setting and Addressing Barriers to Success
Interviewing Skills/Mock Interviews
Personal Money Management and Raising Your Credit Score
Developing a Support System/Mentors
Apprenticeships: What They Are and How to Apply
Workplace Communication and Behaviors
Job Hunting and Development
Rulers and Measuring Tapes
Other:
What long-term effects will this crisis have on you/your family?
Your answer
Are you or anyone in your household considered “high-risk” for COVID-19?
Yes
No
I don't know
Clear selection
Do you depend on public transportation (e.g. city buses, Uber/Lyft, trains)?
Yes
No
Clear selection
How many children (people under 18) live in your household or do you share custody of?
0
1
2
3
4+
Clear selection
How many children, adults with special needs, or elderly people do you need to find care for if you go to work?
0
1
2
3
4+
Clear selection
What is your age?
*
17 or younger
18-24
25-34
35-44
45-54
55-64
65-74
75+
What is your race?
White/Caucasian
Black/African American
American Indian/Alaskan Native
Asian
Hawaiian/P. Islander
Multi-Race
Hispanic
Prefer not to answer
Other:
Clear selection
How many people live in your household? (Include yourself. Do not include roommates you don't financially support or who don't financially support you.)
1
2
3
4
5
6
7
8 or more
Clear selection
What is your approximate HOUSEHOLD income?
No Income
less than $10,000
10,001-$15,000
$15,001- $20,000
$20,001-$30,000
$30,001-$40,000
$40,001- $60,000
$60,001- $80,000
$80,001+
Clear selection
What is your highest education level completed?
Did not graduate high school
High School Graduate/GED
Some additional training, no degree
2 or 4 year college graduate
Other certificate or degree
Other:
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of West Virginia Women Work, Inc..
Report Abuse
Forms
