COTA Foundation - Community Needs Survey
Share your household’s needs in Hilo and on Hawai‘i Island so COTA Foundation can plan meals, clothing, hygiene supplies, household essentials, and scholarships where they’re most needed.
About You (Optional)
Zip Code
Household Size
I am answering on behalf of:
My own household
A community organization or agency
Immediate Needs
In the past 6 months, has your household experienced difficulty affording any of the following?
*
Enough food for everyone in the household
Clothing (for adults or children)
Hygiene items (soap, toothpaste, diapers, etc.)
Household goods (cleaning supplies, kitchenware, linens)
Rent or mortgage
Utility bills (electric, water, gas)
Medical or dental care
Transportation/gas
School supplies or school-related costs
Tuition or educational expenses
None of the above
Other
Which of these is the MOST urgent need for your household right now?
*
Food Security
In the past 12 months, how often did your household worry about running out of food before you had money to buy more?
*
Never
Rarely (1-2 times)
Sometimes (several times)
Often (most months)
Would your household use a weekly hot meal program if one were available nearby?
*
Yes
No
Not sure
Housing & Household Stability
Which best describes your current housing situation?
*
Own home
Renting
Staying with family or friends
Unsheltered/transitional housing
Prefer not to say
In the past year, has your household worried about losing its housing due to rent, utility, or other financial pressure?
*
Yes
No
Not sure
Education & Scholarships
Do you have school-age children (K-12) in your household?
*
Yes
No
If yes, would your household benefit from free school supplies at the start of the school year?
Yes
No
N/A
Does anyone in your household plan to pursue further education (college, trade school, workforce training) in the next 2 years?
*
Yes
No
Not sure
Would a local scholarship program (for tuition, fees, or training costs) be helpful to your household?
*
Yes
No
Not sure
Awareness & Access
Have you or your family used any local assistance programs before (food bank, rental assistance, etc.)?
*
Yes
No
What is the best way to reach you with information about local assistance programs?
*
Text message
Email
Phone call
Social media
Flyers at school or church
Community events
Other
What keeps people in your community from getting help they need?
*
Don’t know what’s available
Transportation to get to programs
Limited hours/scheduling conflicts
Embarrassment or stigma
Language barriers
Application process is too complicated
Other
Open Feedback
Is there anything else you'd like COTA Foundation to know about the needs in your community?
Name
First Name
Middle Name
Last Name
Phone or Email
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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