Community Needs Assessment
We are seeking your assistance to help us better understand the needs of our community so that we can offer programs and services to better serve those in need.
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What is your age? *
Which of the following best represents your racial or ethnic heritage? (check all that apply) *
Required
What is your zip code? *
What is your marital status? *
What is your highest level of education completed? (check all that apply) *
Required
What is your employment status? *
Required
What types of income do you have? (check all that apply) *
Required
If unemployed, are you currently looking for work?
Clear selection
If you are unemployed, please select the reason(s) why that is:
Would you like help with these job related activities? (check all that apply)
How many people are in your household? Include yourself *
What is your housing status? (check all that apply) *
What is your household's total annual income? *
Do you have access to childcare?
If yes, how much do you pay a week?
Have you ever lost a job because you didn't have dependable childcare?
Clear selection
Do you have any of the following housing related needs?
Have you ever been evicted?
Clear selection
Are you in need of help with any of these things:
Do you have any of these financial needs or problems?
Clear selection
Do you have any other needs that need to be addressed?
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