Community Family Needs Survey
Please take 2–3 minutes to answer these questions about your household, needs, and awareness of community resources. Your responses are confidential and will help us better support families in our community.
Family Background
How many children live in your household?
*
What are the ages of the children? (Select all that apply)
*
0–2 years
3–5 years
6–10 years
11–14 years
15–18 years
Other (please specify)
Family Stability & Needs
In the past 12 months, have you experienced any challenges keeping your household stable?
*
Yes
No
Prefer not to say
If yes, which areas were challenging? (Check all that apply)
Housing
Food
Mental or emotional stress
Transportation
Childcare
Other (please specify)
Child Safety & Well-Being
Has a child in your household ever been affected by a situation involving an adult or caretaker outside of the home?
*
Yes
No
Prefer not to say
Do you feel you have enough support to keep your children emotionally and physically safe?
*
Yes
No
Sometimes
Support & Community Needs
What support would help your family stay or remain stable?
Would you use free parenting or family well-being workshops if offered?
*
Yes
No
Maybe
Awareness
Before this survey, were you aware of Noah’s Fund?
*
Yes
No
Follow-up (optional)
Would you like more information or resources?
Yes (provide email/phone)
No
If yes, please provide your email or phone number (optional):
Submit Survey
Should be Empty: