Community Needs Assessment Survey
Completing a community needs assessment survey is essential for several reasons. First, it provides valuable insights into the specific needs and priorities of your community, ensuring that resources are allocated effectively. By sharing your perspectives and experiences, you contribute to a clearer understanding of local challenges, helping to shape initiatives that directly benefit residents. Additionally, your input can influence decision-makers and attract funding for essential services and programs. Ultimately, participating in the survey empowers you to play an active role in improving your community, fostering a sense of connection and shared responsibility among its community members.
This survey will collect information regarding the make up and some demographic information about the members of your household. This information is to get a sense of the households who are responding to the survey and for deduplication uses only. No household demographic information will be released as a part of the needs assessment.
The survey will take approximately 5-10 minutes to complete depending on household size. You will not be able to save for later. Are you willing to complete the survey now?
Yes
No
What county do your currently reside?
*
Please Select
Allen
Bourbon
Chautauqua
Cherokee
Crawford
Elk
Labette
Linn
Montgomery
Neosho
Wilson
Woodson
Which town in Allen County do you currently reside in?
*
Please Select
Bassett
Elsmore
Gas
Humboldt
Iola
La Harpe
Mildred
Moran
Savonburg
Which town in Bourbon County do you currently reside in?
*
Please Select
Bronson
Devon
Fort Scott
Fulton
Garland
Mapleton
Redfield
Uniontown
Which town in Chautauqua County do you currently reside in?
*
Please Select
Cedar Vale
Chautauqua
Elgin
Niotaze
Peru
Sedan
Which town in Cherokee County do you currently reside in?
*
Please Select
Baxter Springs
Columbus
Crestline
Galena
Hallowell
Lowell
Riverton
Roseland
Scammon
Treece
Weir
West Mineral
Which town in Crawford County do you currently reside in?
*
Please Select
Arcadia
Arma
Brazilton
Cherokee
Croweburg
Farlington
Franklin
Frontenac
Girard
Hepler
McCune
Mulberry
Opolis
Pittsburg
Radley
Ringo
Walnut
Yale
Which town in Elk County do you currently reside in?
*
Please Select
Elk Falls
Grenola
Howard
Longton
Moline
Which town in Labette County do you currently reside in?
*
Please Select
Altamont
Bartlett
Chetopa
Dennis
Edna
Labette
Mound Valley
Oswego
Parsons
Which town in Linn County do you currently reside in?
*
Please Select
Blue Mound
Centerville
LaCygne
Linn Valley
Mound City
Parker
Pleasanton
Prescott
Which town in Montgomery County do you currently reside in?
*
Please Select
Caney
Cherryvale
Coffeyville
Dearing
Elk City
Havana
Independence
Liberty
Sycamore
Tyro
Wayside
Which town in Neosho County do you currently reside in?
*
Please Select
Chanute
Earlton
Erie
Galesburg
Saint Paul
Stark
Thayer
Urbana
Which town in Wilson County do you currently reside in?
*
Please Select
Altoona
Benedict
Buffalo
Coyville
Fredonia
Lafontaine
Neodesha
New Albany
Which town in Woodson County do you currently reside in?
*
Please Select
Neosho Falls
Piqua
Toronto
Yates Center
Household's current housing situation?
Please Select
Rent with no subsidy
Own with no subsidy
Rent with rental subsidy
Own with ownership subsidy
Staying with friend/family member
Other
Please write a brief explanation.
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Next
How many individuals live in your household?
*
Please count all adults and children living in your home.
Head of Household
*
Household Member 2
*
Household Member 3
*
Household Member 4
*
Household Member 5
*
Household Member 6
*
Household Member 7
*
Household Member 8
*
Household Member 9
*
Household Member 10
*
Household Member 11
*
Household Member 12
*
Household Member 13
*
Household Member 14
*
Household Member 15
*
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Next
How many individuals in your household have a regular monthly income?
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Please select all sources of income that your household receives.
*
Employment
Rental Income
Stocks/Bonds
Retirement/Pension
Social Security Retirement
Social Security Income (SSI)
Social Security Disability Income (SSDI)
SNAP (Food Stamps)
TANF (Cash Assistance)
Child Support
Alimony/Other Spousal Support
Unemployment
WIC
Housing Choice Voucher (Section 8, etc.)
Child Care Assistance
VA Service Connected Disability Compensation
VA Non-Service Connected Disability Compensation
No Household Income
Other
Employment-Please list the total amount received monthly for all employment income for all household members. (Rounded to the nearest dollar)
*
Rental Income-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Stocks/Bonds-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Retirement/Pension-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Social Security Retirement-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Social Security Income (SSI)-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Social Security Disability Income (SSDI)-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
SNAP (Food Stamps)-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
TANF (Cash Assistance)-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Child Support-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Alimony/Other Spousal Support-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Unemployment-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Housing Choice Voucher (Section 8, etc.)-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Child Care Assistance-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
VA Service Connected Disability Compensation-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
VA Non-Service Connected Disability Compensation-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Other-Please list the total amount received monthly for all members of the household. (Rounded to the nearest dollar)
*
Other-Please list sources of income.
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Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community there is a low cost of living?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is adequate wages/income to live?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the ability to eliminate debts?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the ability to attain financial security?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the availability of financial services?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the availability of financial counseling?
*
Strength
Concern
Opportunity
Need
Excellent
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Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community my family have access to job training/assistance opportunities?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community my family have a variety of employers to choose from?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community my family can earn a living wage?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community my family is able to find employment?
*
Strength
Concern
Opportunity
Need
Excellent
In my community individuals with a criminal history can attain/maintain employment?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
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Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community there is adequate number of financial institutions (banks) to choose from?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is enough commodities (water/groceries/medicine/etc.) to run errands without leaving the community?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the availability of employment for youth?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is public safety?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is accessibility for people with disabilities?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is adequate childcare options?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is vocational (trades-plumbing/electrical/etc.) training and education?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is education for primary (elementary) school children?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is education for secondary (middle/high) school children?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is the ability to obtain a degree with a criminal record?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is the availability to obtain a GED/Adult Education?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is quality, affordable pre-schools?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is quality after school and/or summer programs for youth?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
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Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community there is adequate number of rental units available?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is an adequate number of homes for purchase for homeowners?
*
Strength
Concern
Opportunity
Need
Excellent
In my community housing is safe?
*
Strength
Concern
Opportunity
Need
Excellent
In my community housing is affordable?
*
Strength
Concern
Opportunity
Need
Excellent
In my community housing is available?
*
Strength
Concern
Opportunity
Need
Excellent
In my community utilities are affordable?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the availability of emergency rental assistance?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the availability of emergency utility assistance?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is adequate housing opportunities for individuals 62 and over?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is adequate housing opportunities for disabled individuals and families?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is adequate resources for elderly living assistance?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
My community has access to Section 8 Housing Choice Voucher rental assistance?
*
Strength
Concern
Opportunity
Need
Excellent
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Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community my family has access to a personal car, truck, van or motorcycle?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community we have access to a ride sharing app?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community we have public transportation?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community we have access to walk via sidewalks?
*
Strength
Concern
Opportunity
Need
Excellent
In my community my family has access to a bicycle?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community my family has access to an electric scooter?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community my family has access to a skate board?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community my family has access to private transportation?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community my family is able to carpool?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
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Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community there is access to physical health facilities/services?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to mental health facilities/services?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to substance use facilities/services?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to a local hospital/medical facility?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to pediatric (child) health care facilities/services?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is access to prenatal (pregnancy) health care facilities/services?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is access to dental care?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to healthcare education/prevention programs?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to medical transportation?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to emergency medical services?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access for daily living assistance for elderly/disabled residents?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is the availability of nutritional and exercise programs?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to adequate and healthy foods?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to food assistance programs?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is ability to afford healthy foods?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to emergency food assistance programs and pantries?
*
Strength
Concern
Opportunity
Need
Excellent
Back
Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community there is a YMCA or Boys and Girls Club?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is a recreational center?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is a public library?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is a local pool?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there are religious facilities?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there are neighborhood parks?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there are summer camps/activities for youth?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there are after school programs?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there are year-round recreational activities?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there are summer recreational activities?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to outdoor recreational space/programming?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to indoor recreational space/programming?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there are services and programs for senior citizens?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there are services and programs for youth?
*
Strength
Concern
Opportunity
Need
Excellent
Back
Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community there is a lack of computer/digital literacy?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is a lack of affordable internet services?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is a lack of reliable internet services?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is availability of civic organizations/groups?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is opportunities for citizens to be involved in local decision making processes?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is access to religious groups, organizations, churches, etc?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is a strong sense of neighborhood camaraderie (strong feeling of connection to the community)?
*
Strength
Concern
Opportunity
Need
Excellent
Back
Next
Please select the most appropriate answer for each question listed below utilizing the following scale.
Excellent-extremely good; outstanding Strength-able to withstand pressure Opportunity-stable but much room for improvement Concern - unsatisfactory Need-necessary, required
In my community there is ease of accessing SNAP benefits?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing WIC benefits?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing child care benefits?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing TANF benefits?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing housing subsidies (Section 8 Housing Choice Vouchers)?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing disability resources?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing Social Security Income (SSI)?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing Social Security Disability Income (SSDI)?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing a Social Security Office?
*
Strength
Concern
Opportunity
Need
Excellent
In my community there is ease of accessing Social Security Retirement Income?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing medical insurance?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing Medicaid?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing Medicare?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
In my community there is ease of accessing CHIP (Child Health Insurance Program)?
*
Strength
Concern
Opportunity
Need
Excellent
Not Applicable
Submit
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