Powerful Moms Who Care

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Powerful Moms Who Care - 2022 Survey

Please check out our website (powerfulmoms.org) for more details! All information gathered from this survey is confidential. Only Powerful Moms Who Care staff will have access to the information you provide.

Una encuesta en español también está disponible aquí: https://forms.gle/uqAwFSYd5YkonXCC6
(A Spanish survey is also available here)

Email *

Your phone/ cell number: *

1. Name: *

2. Age:

3. Number of children: *

4. Current city of residence? *

5. How long have you lived at your current residence?

6. Have you ever had difficulty finding affordable housing? Please describe briefly. *

7. Have you ever struggled to find affordable child care options? Please describe briefly. *

8. What problems in your daily life are most frustrating or unfair? *

9. What are the most difficult challenges that your family faces? *

10. Which of the following issues would you like to see changed? (select all applicable) *

Wages

Housing

Child care

Healthcare

Education (for kids)

Education and job training (for you)

Other:

Required

11. Are you currently receiving assistance from any of the following? (select all applicable):

Supplemental Nutrition Assistance Program (SNAP)

Family Employment Program (FEP)

Housing Assistance (housing voucher, Section 8)

Medicaid

Children's Health Insurance Program (CHIP)

Women, Infants and Children (WIC)

I'm not receiving any assistance at this time

Other:

12. What services, assistance and/or programs have been most helpful for you?

13. Would you be interested in having a longer conversation with us about your experiences and ideas for making change? *

Yes

14. What is the best way to contact you? *

Text message

Phone call

Facebook message

Required

15. How did you hear about this survey? *

16. Would you like to receive our monthly e-newsletter? *

Yes

Please send this link to anyone else who might be interested: https://forms.gle/jdoqDd8dEZbgzjqM8

Thank you for taking the time to fill this survey out! ☺ Your valuable information is greatly appreciated, and helps us to better meet individuals in need within the community. Please join our Facebook group to learn about our events: https://www.facebook.com/groups/powerfulmomswhocare. Questions, concerns, or comments? Please contact Jess Roadman or Audrey Mancini at: powerfulmomswhocare@gmail.com / (801) 364-7765 x. 110 or leave comments below.

A copy of your responses will be emailed to the address you provided.

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