Needs Assessment
What do you think are the major causes of poverty where you live?
(check your top 3)
What makes it tough for you and your family to get a job?
(check your top 3)
What services are needed most for children?
To buy your own home, what type of help would you need?
What are the biggest causes of health concerns in your family?
What prevents you from having a “healthy” lifestyle
(check your top 3)
What areas are you presently experiencing difficulties:
(check your top 3)
What do you feel are the biggest problems facing youth (ages 5-17) in the community?
(check up to 3)
What do you feel are the biggest problems facing adults in the community?
(check up to 3)
What barriers do you and your family have in seeking/gaining assistance with your basic needs
Additional Comments:
Your answer
Age
Sex
Ethnicity
Select one or more races that apply
County
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