2023 Community Needs Assessment Survey

This survey should take about 10 minutes.

To view this survey in Spanish, click the button that says "English" in the upper right corner and change it to "Español."

Esta encuesta tomará alrededor de 10 minutos.

Para ver esta encuesta en español, haga clic en el botón que dice "English" en la esquina superior derecha y cámbielo a "Español".

What town do you live in?* This field is required.Scroll down to view all options

What is your age?* This field is required.

What is your gender?* This field is required.Scroll down to view all options

What is your ethnicity?* This field is required.

Hispanic, Latino or Spanish Origins

Not Hispanic, Latino or Spanish Origins

Do not wish to disclose

Which of the following represents your race?* This field is required.

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian and Other Pacific Islander

White

Multi-race (two or more of the above)

Other

Do not wish to disclose

What is the highest level of education that you have completed?* This field is required.Scroll down to view all options

What is your marital status?* This field is required.

Single

Married

Widowed

Divorced

Separated

Do not wish to disclose

Do you have military experience?* This field is required.

Yes, I am active duty

Yes, I am a veteran

My spouse is active duty

My spouse is a veteran

No, I do not have military experience

What is your household size?* This field is required.

Do you have dependent children?* This field is required.

Yes

Yes, but they don't live with me

What is your household type?* This field is required.

Single Person

Two Adults No Children

Single Parent

Two Parent Household

Multiple Generations in Household

Other

Do you feel safe sending your child to school?* This field is required.

Yes

If not, then why?* This field is required.Do you feel safe sending your child to school?

Does your child feel safe at school?* This field is required.

Yes

If not, then why?* This field is required.Does your child feel safe at school?

What are your sources of household income?* This field is required.Check all that apply

Employment Income

No Income

Unemployment benefits

TANF (State cash assistance)

Child Support or Alimony

SSDI/SSI

Social Security

Pension or Retirement Income

Self-employment

Other

If Other, please explain* This field is required.What are your sources of household income?

What is your employment status?* This field is required.

Full-time

Part-time

Temporary

Unemployed

Unable to work

Other

Are transportation issues affecting your employment status?* This field is required.

Yes

Did you have any of the following problems getting or keeping a job within the past 3 years?* This field is required.Scroll down to view all options

I have had no difficulty getting or keeping a job

Jobs were not available

No response to application

Transportation

Lack of required equipment/clothing

Lack of job skills

Language barriers

Lack of childcare

Substance abuse

Criminal background

Domestic violence

Sexual harassment

Lack of a permanent address

Mental health

Health issues

Debilitating disability

Lack of access to cell phone service

Lack of access to the internet

What is your annual household income?* This field is required.Household of 1

under $13,590

$13,591 - $16,988

$16,989 - $17,667

$17,668 - $18,754

$18,755 - $20,385

$20,386 - $25,142

$25,143 - $27,180

$27,181 - $31,937

$31,938 - $33,975

$33,976 - $40,770

$40,770+

What is your annual household income?* This field is required.Household of 2

under $18,130

$18,131 - $22,888

$22,889 - $23,803

$23,804 - $25,268

$25,269 - $27,465

$27,466 - $33,874

$33,875 - $36,320

$36,321 - $43,029

$43,030 - $45,775

$45,776 - $54,930

$54,931+

What is your annual household income?* This field is required.Household of 3

under $23,030

$23,031 - $28,788

$28,789 - $29,939

$29,940 - $31,781

$31,782 - $34,545

$34,546 - $42,606

$42,607 - $46,060

$46,061 - $54,121

$54,122 - $57,575

$57,576 - $69,090

$69,091+

What is your annual household income?* This field is required.Household of 4

under $27,750

$27,751 - $34,688

$34,689 - $36,075

$36,076 - $38,295

$38,296 - $41,625

$41,626 - $51,338

$51,339 - $55,500

$55,501 - $65,213

$65,214 - $69,375

$69,376 - $83,250

$83,251+

What is your annual household income?* This field is required.Household of 5

under $32,470

$32,471 - $40,588

$40,589 - $42,211

$42,212 - $44,809

$44,810 - $48,705

$48,706 - $60,070

$60,071 - $64,940

$64,941 - $76,305

$76,306 - $81,175

$81,176 - $97,410

$97,411+

What is your annual household income?* This field is required.Household of 6

under $37,190

$37,191 - $46,488

$46,489 - $48,347

$48,348 - $51,322

$51,323 - $55,785

$55,786 - $68,802

$68,803 - $74,380

$74,381 - $87,397

$87,398 - $92,975

$92,976 - $111,570

$111,571+

What is your annual household income?* This field is required.Household of 7

under $41,910

$41,911 - $52,388

$52,389 - $54,483

$54,484 - $57,836

$57,837 - $62,865

$62,866 - $77,534

$77,535 - $83,820

$83,821 - $98,489

$98,490 - $104,775

$104,776 - $125,730

$125,731+

What is your annual household income?* This field is required.Household of 8+

under $46,630

$46,631 - $58,288

$58,289 - $60,619

$60,620 - $64,349

$64,350 - $69,945

$69,946 - $86,266

$86,267 - $93,260

$93,261 - $109,581

$109,582 - $116,575

$116,576 - $139,890

$139,891+

What is your current housing status?* This field is required.

Own

Rent

Hotel/Motel

Staying with friends or family

Homeless - Street/Car

Homeless - Shelter/Transitional housing

Nursing/long term care

Assisted living

Group home

Halfway house

Have you ever owned a house?* This field is required.

Yes

Have you ever been foreclosed on?* This field is required.

Yes

I am currently in foreclosure

Have you been evicted within the past 3 years?* This field is required.

Yes

I am currently being evicted

Do you feel that you have safe, decent, affordable housing?* This field is required.

Yes

Do you feel safe in your neighborhood?* This field is required.

Yes

What are the greatest challenges your household is currently facing?* This field is required.

Had you previously heard of Access Community Action Agency?* This field is required.

Yes

Are you a customer of Access Community Action Agency?* This field is required.

Yes

Have you applied for energy assistance?* This field is required.

Yes, I receive energy assistance

Yes, I applied but was over income

I have applied before but do not receive it now

No, I don't think I qualify

I don't need it

I have never heard of the energy assistance program

Are there services for the homeless in your area?* This field is required.

Yes

Unsure

Do you know that if you are homeless the first step in getting help is to dial 211?* This field is required.

Yes

Unsure

Is there a need for a no-freeze shelter in your area?* This field is required.

Yes

Unsure

Do you have reliable phone service?* This field is required.

Yes

Do you have reliable access to the internet?* This field is required.

Yes

Did you know that Access has volunteering opportunities?* This field is required.

Yes

Does your household run out of food before the end of the month?* This field is required.

Yes

Do you utilize any of the following?* This field is required.

Food Pantries

SNAP/ Food Stamps

Both

Neither

Are there things you need but struggle to pay for?* This field is required.

Yes

If Yes, please explain* This field is required.Are there things you need but struggle to pay for?

What do you view as major causes of poverty in your area?* This field is required.Scroll down to view all options

No employment opportunities

Employment that provides insufficient income

Lack of education

Cost of housing

Cost of living

Substance abuse

Affordable childcare

Other

If Other, please explain* This field is required.What do you view as major causes of poverty in your area?

Have you experienced a stressful event in the last 3 years?* This field is required.

Yes

If Yes, please explain* This field is required.Have you experienced a stressful event in the last 3 years?

Do you or someone close to you have an addiction?* This field is required.

Yes

Do you experience chronic illness?* This field is required.

Yes

Do you experience mental illness?* This field is required.

Yes

Where do you turn when you are in crisis?* This field is required.Scroll down to view all options

Family

Friends

Faith Based Organizations

Community Service Agencies

Physician, therapist, APRN, psychiatrist, or other healthcare professional

I have no one to turn to

Other

If Other, please explain* This field is required.Where do you turn when you are in crisis?

Did the COVID-19 pandemic affect your household in any of the following ways?* This field is required.Scroll down to view all options, check all that apply

I tested positive for COVID

Someone close to me tested positive for COVID

Someone close to me was hospitalized for COVID

Someone close to me passed away due to COVID

I had to quarantine

I had to wear a mask

I was an essential worker

I was an essential worker working directly with individuals diagnosed with COVID

I was laid off due to COVID

I experienced financial strain due to COVID

Increase in housing prices

Increase in grocery and essential item prices

Lack of availability of groceries and essential items

I experienced difficulty receiving routine medical care

My child's school or daycare was closed

I was unable to work because my child was home

I had to homeschool my child

My child's social development was affected due to virtual learning

I experienced an increase in anxiety, fear, sadness or loneliness due to COVID

My business had a loss of income due to COVID

I had to close my business due to COVID

I experienced isolation due to COVID

I was unable to visit family/friends

I was unable to visit a family member in senior housing, retirement home or assisted living

Community events that I regularly attend were cancelled

Travel plans were cancelled

Other

If Other, please explain* This field is required.Did the COVID-19 pandemic affect your household in any of the following ways?

Within the last 12 months have you utilized a service that has been cut and is no longer available?* This field is required.

Yes

If Yes, what was the name of the service that was cut?* This field is required.

What is the most helpful resource that you are aware of?* This field is required.

What do you see as the important needs of the community?* This field is required.

What important information do you think we should know?* This field is required.