PRE-Survey

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

PRE-Survey

Please answer questions below based on your views of poverty and how it impacts on people. You will get an opportunity to complete a POST-Survey to share your reflections on the experience. Thanks for participating today.

DATE OF POVERTY SIMULATION (Today's Date) *

YYYY

ANNONYMOUS SURVEY

All survey answer anonymous. Please use a Nickname or Pseudonym to complete this survey and protect the privacy of your answers. Use the same Nickname or Pseudonym to complete the POST-Survey. Thanks!

Nickname or Pseudonym (use same on the POST Survey) *

Please rank the following from 1 (most) to 5 (least) for how influential they generally are in causing poverty: *

Poor individual choices

Lack of knowledge and skills

Lack of connections and Relationships

Lack of resources

Broken policies and systems

Police-Community Relations

The best thing that our community can do to address poverty: (Rank the following from 1 (most) to 5 (least) for their effectiveness to address poverty): *

Financial/Material support programs

Education and counseling programs

Advocate for policy and systems change

Build collaboration between businesses, government, faith, education and non-profit

Build direct relationships with low-income families and promote leadership in communities impacted by poverty

Of the things listed please pick 5 you believe would have the most impact in helping to address poverty: *

Affordable health care

Being politically informed and organized to influence laws and policies

Being well connected in the community

Access to quality education

Amount of living wage jobs

Having supportive personal relationships

Safety of neighborhoods

Availability of safe, affordable housing

Access to material resources and assistance

Relationships with police and other government agencies

Access to reliable transportation

Required

Prior to this Simulation Experience... (Check all that apply): *

I regularly interact with people who live in poverty

I do not regularly interact with people who live in poverty

I am clear about my understanding of and my assumptions about poverty

I am NOT clear about my understanding or about my assumptions about poverty

I am involved in activities to address poverty in my community

I am NOT involved in activities to address poverty in my community

I provide input on policies, programs, and activities the business/organization I work with have that impact people living in poverty

I DO NOT provide input on policies, programs, and activities the business/organization I work with have that impact people living in poverty

I am involved in efforts to influence public policy that address poverty in my community

I am NOT involved in efforts to influence public policy that address poverty in my community

Other:

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of AnswerPoverty Inc.

Does this form look suspicious? Report

Forms