GenaShaes House Needs Assessment

  • GenaShaes House Needs Assessment

    Your voice matters. Please complete this brief survey to help us better serve women, pregnant moms, and families in Virginia. All responses are confidential.

  • SECTION 1: About You

  • Format: (000) 000-0000.
  • What is your age?*
  • What is your current status?*
  • How many children do you have?*
  • What City do you currently reside?*
  • What is your current living situation?*

  • SECTION 2: Needs & Challenges

  • What are your top challenges right now?*
  • What services would you like to see in your area?*
  • Have you used local agency/nonprofit services before?*

  • SECTION 3: Moving Forward

  • Would you be interested in any of these programs from GenaShaes House?*
  • How would you prefer to be contacted for future services/events?*
  • Would you like to be notified when our transitional home opens and services begin?*

  • Section 4: GenaShaes House Workshops

  • As we prepare to open GenaShaes House Transitional Home, we'd love to offer workshops to help support and empower you. What topics would you be interested in? (Select all that apply):*
  • Preferred way to attend*

  • Thank you for taking the time to complete this survey. We look forward to connecting with you.

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