Language
English (US)
Korean
Chinese (Simplified Han)
Chinese (Traditional Han)
Filipino
Hindi
Vietnamese
Khmer
Thai
AJSOCAL Community Needs Survey
DEMOGRAPHIC INFORMATION
Please tell us a little bit about yourself and the communities you are a part of.
1. What is your home zip code?
2. How old are you?
18-24
25-34
35-44
45-54
55-64
65-74
75 or older
3. What is your gender identity?
Woman
Man
Non-binary/Gender non-conforming
Gender neutral
Prefer not to say
Please add if not listed
4. What race/ethnicity groups do you identify with (Select all that apply)
American Indian/Alaska Native
Asian/Asian American
Black/African American
Hispanic/Latine/Latino/Latinx
Native Hawaiian or Pacific Islander
White/Caucasian
Prefer not to say
Please add if not listed
5. Select all the Asian subgroups you identify with (Select all that apply)
Bangladeshi
Laotian
Bhutanese
Malaysian
Burmese
Mien
Cambodian
Mongolian
Chinese
Nepalese
Filipino
Pakistani
Hmong
Sikh
Indian
Singaporean
Japanese
Sri Lankan
Korean
Taiwanese
Indonesian
Thai
I do not identify as Asian or Asian American
Vietnamese
Please add if not listed
6. Select the Pacific Islander subgroups you identify with (Select all that apply)
Chamorro
Native Hawaiian
Chuukese
Palauan
Guamanian
Papau New Guinean
Fijian
Samoan
French Polynesian
Tahitian
Kosraean
Tokelauan
Maori
Tongan
Marshallese
I do not identify as Pacific Islander
Please add if not listed
7. Which generation best describes you?
First (Born outside of the US and immigrated as an adult)
1.5 (Born outside of the US and immigrated as a child)
Second (Parents immigrated to the US and you were born here)
Third or later (Grandparents immigrated to the US and your parents and you were born here)
8. Which of these describes your household income last year?
< $10,000
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $100,000
> $100,000
Prefer not to say
9. Select any of the below communities you identify with (Select all that apply)
Individuals with disability
Refugee Community
Foster youth community
Senior Community (60+)
Indigenous community
Veteran Community
Immigrant community (including undocumented)
Unhoused/Homeless Community
LGBTQ+ Community
Prefer not to say
I do not identify with any of these communities
Please add if not listed
10. What language(s) do you and people in your household speak (Select all that apply)?
American Sign Language
Marshallese (language)
Bengali (language)
Native Hawaiian (language)
Burmese (language)
Nepali (language)
Cantonese (language)
Punjabi (language)
Chamorro (language)
Samoan (language)
Chuukese (language)
Tagalog (language)
Hindi (language)
Tamil (language)
Indonesian (language)
Thai (language)
Japanese (language)
Tongan (language)
Khmer (language)
Urdu (language)
Korean (language)
Vietnamese (language)
Mandarin (language)
Please add if not listed
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Community Issues
Think for a moment about your daily life and what the greatest needs and challenges are for you, your family, and your friends.
11. Please review the list of issues on this page and on the next. Which of the issues below are most important to you, your family, and friends? Check your TOP 3 ISSUES.
ACCESS TO HEALTH INSURANCE (ex: getting health insurance coverage like Medi-Cal, Covered CA, Medicare, or private insurance; medical bills or debt; being denied insurance coverage)
ACCESS TO HIGHER EDUCATION/COLLEGE (ex: admissions, financial aid, campus safety, mental health care, food & housing insecurity)
ACCESS TO MENTAL HEALTH SERVICES (ex: access to medication, therapy, or treatment; assistance with medical grievances, mental health concerns, mental health resources, support groups)
ACCESS TO PHYSICAL HEALTH SERVICES (ex: access to medication, therapy, or treatment; assistance with medical grievances, transportation, nutritional food, disability, physical health conditions)
ACCESS TO QUALITY EDUCATION (K-12) (ex: expulsion/suspension, learning disabilities, language access, mental health, special education, school bullying, college readiness, English Language Learners)
ANTI-ASIAN DISCRIMINATION (ex: physical assault, verbal harassment, access to equal housing/employment opportunities, pay discrepancies, access to public services, language access)
COMMUNITY ENVIRONMENT (ex: access to transportation, contamination or pollution, crime, green spaces, neighborhood safety, access to health & fresh food, food desert)
DOMESTIC VIOLENCE includes violence by a spouse, person you dated, or family member (ex: access to support groups, family safety/child safety, personal safety, restraining orders, violence prevention, legal services, financial security)
EMPLOYMENT (ex: discrimination, criminal record barriers/expungement (repair), accessibility or affordability to childcare, owed wages, overtime, rest/meal breaks)
FAMILY AND CUSTODY (ex: adoption, conservatorship, custody issues, divorce, emancipation, guardianship, neglect or abuse, parentage, support payments)
FINANCE/FINANCIAL SECURITY (ex: bankruptcy, collections/ creditors, debt, childcare accessibility or affordability, lack of income or employment, loans, unfair business practices, credit report)
GOVERNMENT & PUBLIC BENEFITS (ex: CalFresh (food aid), CalWORKS or Cash Aid, Cash Assistance for Immigrants, General Relief/Assistance, Social Security)
HOUSING (ex: habitability, unsafe conditions, eviction/foreclosure, housing accessibility or affordability, discrimination, landlord/tenant relations, rent issues, Section 8 or subsidized housing)
IMMIGRATION (ex: citizenship, asylum, removal defense, immigration detention, DACA, family-based petitions, human trafficking (T Visa), victim of a past crime as an immigrant (U Visa), notario fraud)
LANGUAGE ACCESS (ex: language barriers or lack of resources for essential services, government benefits, utilities, companies, public services, court system, law enforcement)
PROTECTING ELDERS & SENIORS (ex: conservatorships, elder abuse, food security/access to nutritional food, financial abuse, financial scams, long-term care, safe & adequate housing, wills)
SEXUAL ORIENTATION & GENDER IDENTITY (ex: access to reproductive & sexual health services, harassment, domestic violence, access to gender affirming care/medication/services, discrimination, sex trafficking, mental health care)
VOTING RIGHTS (ex: access to translated voting materials, ability to bring a translator to the voting booth, access for people with disabilities, discrimination by poll workers, voting registration)
12. Why are your top 3 issues important to you, your family, and friends?
13. Who do you trust to help with your top 3 issues (such as a family member, community organization, social worker, lawyer, or faith/religious leader, etc.)?
14. Why do you trust them?
15. Do you think a lawyer can help you address any of your top 3 issues?
Yes
No
I don't know
16. From what other sources do you receive trusted information?
Word of mouth from family/friends
WeChat
WhatsApp
Kakao Talk
Line
Signal
Facebook
Instagram
YouTube
TV
Newspaper
Radio
Other sources
Barriers to accessing or using resources/services
17. What are some concerns you have when accessing or using resources/services? Mark all that apply.
I do not know what resources I can access or what services I am eligible for
Racism or discrimination when accessing services or resources
No resources or information in my language
Bad experience with community resources in the past
I do not trust community organizations
I rely on other people to help me access resources (like a family member or a friend)
Immigration concerns
No permanent address
I am not comfortable reading or writing
No safe or secure housing
I am not comfortable using technology or the internet
Criminal record/conviction
No reliable or affordable phone
Discrimination because of sexual orientation and/or gender identity
No reliable or affordable internet
Fear of retaliation or negative consequences
No reliable or affordable transportation
Fear of being judged, shamed, embarrassed, or scapegoated
No identity documents
Fear of physical harm
I do not trust lawyers
I do not trust the government/government services
I do not trust law enforcement
Other reason, please specify
AJSOCAL Trust & Reputation
AJSOCAL offers free legal help, engages in impact litigation and advocates for policy change. It prioritizes the most vulnerable members of Asian American and Pacific Islander communities while advocating for civil rights and social justice. You may know AJSOCAL by its former names: Asian Pacific American Legal Center (APALC) Asian Americans Advancing Justice - Los Angeles
18. How familiar are you with AJSOCAL?
Not at all familiar
Slightly familiar
Somewhat familiar
Moderately familiar
Very familiar
19. If you need free legal help, how likely are you to contact AJSOCAL?
Very unlikely
Unlikely
Likely
Very likely
I do not know
Please explain:
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Community Issues in detail
20. Do any of these issues around ACCESS TO HEALTH INSURANCE affect you, your family, or friends? Please mark all that apply.
Access to Homecare
Access to Covered California plans
Access to Long-term healthcare facilities
Access to mental health coverage
Access to Medicare
Access to private insurance
Access to Medi-Cal
Medical bills or debt
Technology-related barriers (online applications)
Language barriers
I need more information about ACCESS TO HEALTH INSURANCE
Denial of health care coverage
No, ACCESS TO HEALTH INSURANCE issues do not affect me, my family, or my friends
Other, please specify:
21. Do any of these issues around ACCESS TO HIGHER EDUCATION/COLLEGE affect you, your family, or friends? Please mark all that apply.
Admissions
Mental health care
Application process
Food insecurity
Financial aid
Health care
Housing insecurity
Language barriers
Technology-related barriers
I need more information about ACCESS TO HIGHER EDUCATION
No, ACCESS TO HIGHER EDUCATION issues do not affect me, my family, or my friends.
Other, please specify:
22. Do any of these issues around ACCESS TO MENTAL HEALTH SERVICES affect you, your family, or friends? Please mark all that apply.
Access to medication
Mental health concerns
Access to care
Mental health resources
Assistance with grievances
Support groups
Billing problems
Conservatorship
Denial of mental health care services
Language barriers
Disability
Providers who look like me
Technology-related barriers
Providers who relate to my cultural background
Involuntary psychiatric holds (5150/5250)
Provides who speak my language
I need more information about ACCESS TO MENTAL HEALTH SERVICES
No, ACCESS TO MENTAL HEALTH SERVICES issues do not affect me, my family, or my friends.
Other, please specify:
23. Do any of these issues around ACCESS TO PHYSICAL HEALTH SERVICES affect you, your family, or friends? Please mark all that apply.
Access to medication
Disability
Access to care
Physical health conditions
Assistance with grievances
Insurance denial of services
Billing problems
Language barriers
Advance healthcare directive
Providers who look like me
Technology-related barriers
Providers who relate to my cultural background
Access to nutritious food
Providers who speak my language
I need more information about ACCESS TO PHYSICAL HEALTH SERVICES
No, ACCESS TO PHYSICAL HEALTH SERVICES issues do not affect me, my family, or my friends.
Other, please specify:
24. Do any of these issues around ACCESS TO QUALITY EDUCATION (K-12) affect you, your family, or friends? Please mark all that apply.
Expulsion or Suspension
Special education (including IEP/504)
Learning Disabilities
Technology-related barriers
Language barriers in school or with school staff
Bilingual education
School bullying
English language learners
Student mental health
Availability of Asian American, Native Hawaiian, and Pacific Islander ethnic studies classes
I need more information about ACCESS TO QUALITY EDUCATION (K-12)
No, ACCESS TO QUALITY EDUCATION (K-12) issues do not affect me, my family, or my friends.
Other, please specify
25. Do any of these issues around ANTI-ASIAN/NHPI DISCRIMINATION affect you, your family, or friends? Please mark all that apply.
Verbal harassments/target of racial slurs
Access to employment opportunities
Mocking of accents
Pay/wage discrepancies
Access to housing
Invisibility
Access to public services
Feeling threatened/fear of safety
Technology-related barriers
Being scapegoated
Language barriers
I need more information about ANTI-ASIAN/NHPI DISCRIMINATION
No, ANTI-ASIAN/NHPI DISCRIMINATION issues do not affect me, my family, or my friends.
Other, please specify:
26. Do any of these issues around COMMUNITY ENVIRONMENT affect you, your family, or friends? Please mark all that apply.
Access to transportation
Access to healthy & fresh food
Crime
Affordable housing
Green spaces/parks
Homelessness
Neighborhood saftey
Walkability
Pollution/contamination
I need more information about COMMUNITY ENVIRONMENT
No, COMMUNITY ENVIRONMENT issues do not affect me, my family, or my friends.
Other, please specify:
27. Do any of these issues around EMPLOYMENT affect you, your family, or friends? Please mark all that apply.
Workers rights (overtime, meal/rest breaks, minimum wage)
Wrongful termination
Owed wages
Injured on the job
Discrimination
Workplace harassment/violence
Childcare accessibility/affordability
Criminal record
Technology-related barriers
Transportation-related barriers
Lack of income or employment
I need more information about EMPLOYMENT
No, EMPLOYMENT issues do not affect me, my family, or my friends.
Other, please specify:
28. Do any of these issues around FAMILY & CUSTODY affect you, your family, or friends? Please mark all that apply.
Adoption
Visitation
Conservatorship
Guardianship
Custody Issues
Parentage
Emancipation
Support payments
Neglect or Abuse of Minors
Financial hardship
Language barriers
Family/domestic violence
I need more information about FAMILY & CUSTODY
No, FAMILY & CUSTODY issues do not affect me, my family, or my friends
Other, please specify:
29. Do any of these issues around FINANCE/FINANCIAL SECURITY affect you, your family, or friends? Please mark all that apply.
Bankruptcy
Student loan debt
Collections
Unfair business practice
Debt
Credit report/history
Childcare accessibility/affordability
Criminal record barriers/repair
Lack of income or employment
Language barriers
Loans
High-interest payday loans
Technology-related barriers
Housing insecurity
Medical bills or debt
Food insecurity
Taxes
Transportation insecurity
I need more information about FINANCE/FINANCIAL SECURITY
No, FINANCE/FINANCIAL SECURITY issues do not affect me, my family, or my friends
Other, please specify
30. Do any of these issues around GOVERNMENT & PUBLIC BENEFITS affect you, your family, or friends? Please mark all that apply.
CalFresh (food aid)
Technology-related barriers
CalWORKS or Cash Aid
Fear of public charge
Cash Assistance Program for Immigrants
Social Security Disability Insurance/ Supplemental Security Income
Medi-Cal
General Relief/General Assistance Program
Medicare
Immigration Status & Public Charge
Appeals on denials of benefits
Language barriers
I need more information about GOVERNMENT & PUBLIC BENEFITS
No, GOVERNMENT & PUBLIC BENEFITS issues do not affect me, my family, or my friends.
Other, please specify:
31. Do any of these issues around HOUSING affect you, your family, or friends? Please mark all that apply.
Eviction
Housing Discrimination
Foreclosure
Landlord/Tenant relations
Home ownership accessibility/ affordability
Rent Increase/Rent Cap issues
Homelessness/houselessness
Section 8/Subsidized Housing
Housing affordability
Overcrowded housing
Security Deposit
Habitability (repairs, utilities, pests, heating, water, etc.)
Harassment
Safety/Security
Neighbor issues
Temporary Housing (motels/hotels)
Language barriers
Living with relatives/friends
Technology-related barriers
Living in a car
I need more information about HOUSING
No, HOUSING issues do not affect me, my family, or my friends.
Other, please specify:
32. Do any of these issues around IMMIGRATION affect you, your family, or friends? Please mark all that apply.
Victim of a crime (U Visa)
Notario Fraud
Citizenship
Asylum
Removal Defense
VAWA - Residency petition as a survivor of domestic violence
Immigration Detention
Criminal record repair/expungement
DACA
Technology-related barriers
Family-based residency petitions
Language barriers
Human Trafficking (T Visa)
I need more information about IMMIGRATION
No, IMMIGRATION issues do not affect me, my family, or my friends.
Other, please specify:
33. Do any of these issues around LANGUAGE ACCESS (e.g., language barriers in accessing services) affect you, your family, or friends? Please mark all that apply.
Government benefits
Mental health care
Utility companies
Legal services/Court system
Public services
Law enforcement
Education services
Health care
Technology use & services
I need more information about LANGUAGE ACCESS
No, LANGUAGE ACCESS issues do not affect me, my family, or my friends.
Other, please specify:
34. Do any of these issues around DOMESTIC VIOLENCE affect you, your family, or friends? Please mark all that apply
Access to support groups
Restraining orders
Family safety/child safety
Legal Services
Personal safety
Technology-related barriers
Preventing interpersonal, domestic, and dating violence
Language barriers
Financial security
Access to safe space
Violence Against Women Act (VAWA)
Fear of retaliation
Victims of Crime (U Visa)
I need more information about DOMESTIC VIOLENCE
No, DOMESTIC VIOLENCE issues do not affect me, my family, or my friends.
Other, please specify:
35. Do any of these issues around PROTECTING ELDERS & SENIORS affect you, your family, or friends? Please mark all that apply.
Access to and safe use of medication
Financial Abuse
Access to health care
Financial scams
Conservatorship
Safe & adequate housing
Elder Abuse
Long-term care (nursing homes or assisted living)
Access to Senior Housing
Powers of Attoreny
Food Security/Access to nutritious food
Wills/Advanced healthcare directives
Technology-related barriers
Access to trusted providers/caretakers
Language barriers
Transportation barriers
In-home care
I need more information about PROTECTING ELDERS & SENIORS
No, PROTECTING ELDERS & SENIORS issues do not affect me, my family, or my friends
Other, please specify:
36. Do any of these issues around SEXUAL ORIENTATION & GENDER IDENTITY affect you, your family, or friends? Please mark all that apply.
Access to reproductive & sexual health services
Housing discrimination
Harassment
Mental health care
Domestic Violence, Interpersonal violence
Sex trafficking
Access to gender affirming care, medication, and services
Technology-related barriers
Employment discrimination
Language barriers
Health care discrimination
Providers who can relate to my needs
I need more information about SEXUAL ORIENTATION & GENDER IDENTITY
No, SEXUAL ORIENTATION & GENDER IDENTITY issues do not affect me, my family, or my friends.
Other, please specify:
37. Do any of these issues around VOTING RIGHTS affect you, your family, or friends? Please mark all that apply .
Ability to register to vote
Disability access to polling places
Lack of in-language voting materials
Lack of in-language support at vote centers
Lack of information on rights of voters
Transportation barriers
Technology-related barriers
Work-related barriers
Language barriers
Lack of non-partisan voter education materials
Discrimination by poll workers
Lack of trusted messengers
I need more information about VOTING RIGHTS
No, VOTING RIGHTS issues do not affect me, my family, or my friends.
Other, please specify
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Final Section!
38. Is there anything else you would like to share with AJSOCAL about what your community needs?
Please enter your EMAIL so we can send you the incentive. The email will be used only for the distribution of the incentive.
example@example.com
If you have more thoughts to share, we invite you to join our focus group sessions to discuss your community’s needs in more detail. Please enter your email or phone number so we can reach out to you to schedule the focus group
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