Community Needs Survey/ Encuesta sobre necesidades comunitarias
Haga la encuesta en español: http://tiny.cc/bk6ctz

Fourth Plain Forward is gathering information from renters in neighborhoods along Fourth Plain Boulevard in Central Vancouver about the effects of the COVID-19 pandemic and needs within our community. This is an anonymous survey and should take less than five minutes to complete. Take the survey for a chance to win a $50 gift card.

Please contact our staff at 360-947-7669 or email us at 4thplainforward@gmail.comif you have any questions or need help filling out the survey.
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Phone Number *
1. Are you currently employed? *
1. If you have recently lost your job, where are you getting income? *
3. If you have lost your job, are you actively looking for employment? *
4. For the items below, please select the level to which your household's need is being met. 1=none of your need being met to 5=all of your need being met. If an item does not pertain to you, please select "Does Not Apply". *
1 - NONE of my need is being met
2 - SOME of my need is being met
3 - HALF of my need is being met
4 - MOST of my need is being met
5 - ALL of my need is being met
Does not apply
Stress/Emotional Support
Transportation
Accessing mental healthcare
Obtaining food/water
Obtaining medications
Access to the internet
Access to the outdoors
Accessing childcare
Accessing information about COVID-19
5. What child care challenges are you experiencing due to COVID-19? (check all that apply) *
Required
6. After the eviction moratorium is lifted, are you able to pay your current and any back rent/mortgage? (check all that apply) *
Required
7. Is there anything else you would like to share about impacts of COVID-19 on your household or the Fourth Plain community? *
8. How many people currently live in your household, including yourself? *
9. Which one or more of the following describes your race? (check all that apply) *
Required
10. Are you Hispanic or Latino/a? *
11. What is your zip code? (e.g. 98661) * *
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