Community Needs Assessment
Kankakee County Community Services, Inc. would like to understand the challenges and needs of residents like you. The information collected will be used to ensure services are available in the future to address Kankakee County residents’ needs. All survey responses will be kept confidential.
Sign in to Google to save your progress. Learn more
Email *
Do you live in Kankakee County? PLEASE STOP IF YOU DO NOT LIVE IN KANKAKEE COUNTY.  *
If yes, What is your Zip Code? *
In the past 12 months, what is the single greatest challenge you and your household have experienced? SELECT ONLY ONE *
In the past 12 months, have you or any members of your household received any services from Kankakee County Community Services, Inc. *
If yes, what services did you or anyone in your household receive from KCCSI? CHECK ALL THAT APPLY *
Required
Overall, how would you rate the services you or members of your household received from KCCSI *
Why did you select the choice you made regarding your rating of services? If you select "Not Applicable" please type Not Applicable below. *
What suggestions do you have for changes or additions to the services provided by us? If you don't have any input, please type Not Applicable. *
In the past 12 months, from which agencies/organizations in Kankakee County have you or members of your household received services? If none, please type Not Applicable. *
Which of the following challenges or barriers have you or members of your household experienced accessing services? *
Required
Which services, if any, have you or members of your family needed that were not available in Kankakee County. If none, type Not Applicable. *
With which of the following health needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
With which of the following housing needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
With which of the following adult education needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
With which of the following employment needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
ANSWER THIS QUESTION ONLY IF THERE ARE CHILDREN UNDER THE AGE OF 18 IN YOUR HOUSEHOLD. With which of the following child care and child development needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
With which of the following financial/legal (income management) needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
With which of the following food and nutrition needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
With which of the following family support needs could you or someone in your household use help? CHECK ALL THAT APPLY *
Required
In the past 12 months did you or someone in your household participate in the following: Registered to vote in a local, state, or national election *
In the past 12 months did you or someone in your household participate in the following: Volunteered or participated in an organization, association, or group, such as PTA, Kiwanis, or church group *
In the past 12 months did you or someone in your household participate in the following: Worked with others to solve a community problem *
Do you have high-speed internet access at home via a smartphone, tablet, iPad, desktop or laptop computer or other device? *
Do you receive reduced price internet service? *
What is your gender? *
What is your age range? *
Are you of Hispanic, Latinx, or Spanish origin?         *
What is your race? CHECK ALL THAT APPLY *
Required
How many people live in your household? *
What is the primary language spoken at home? *
What is your annual household income? Please consider all sources of income, before taxes, for everyone living with you during the most recent year.   *
What is your full name &  telephone number? OPTIONAL
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy