Request edit access
Community Needs Assessment
Please answer ALL questions. Click SUBMIT when done. Our mission is "Helping kids by helping parents." We are a parent support committee gathering data to provide a community resource fair based on responses collected. ALL INFORMATION IS KEPT PRIVATE AND IS NOT SHARED. Thank you for taking time to respond. 
Sign in to Google to save your progress. Learn more
Children's Ages  *
Required
Where do you live? (Enter zip code below) *
What is your current employment status? *
Tribal Affiliated? *
Are you an Active Duty Service Member/Spouse/Dependent? *
Are you a veteran/spouse/dependent of veteran? *
In the last 90 days, what has been your primary form of transportation? (check all that apply) *
Required
In the last 90 days, what have been your needs for your child/children? (check all that apply) *
Required
If "Other" selected, please describe
In the last 90 days, has your family struggled to afford any of the following? (check all that apply) *
Required
If "Other" selected, please type items needed
How did you learn about this survey? *
If "Other" selected, please describe below
What services/information/resources would be helpful for you to overcome the challenges you face as a caregiver in Comanche County? (check all that apply) *
Required
If "Other" selected, please describe your needs
If you would like to provide additional feedback or join the Comanche County Community Coalition, please provide your name and email address.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of WWT.

Does this form look suspicious? Report

Google Forms