Community Solutions CDC Community Needs Assessment
To better cater our programs and services, please complete this simple survey. All information collected is CONFIDENTIAL
Male, Female or Other *
Race/Ethnic Background *
What is your current age? *
Zip Code *
Married, Single or Divorced *
Number of individuals in your household *
Employed, Unemployed or Disabled *
Highest Level of Education Completed *
Do you utilize public transportation (SEPTA)?
Annual Household Income *
Are you a registered voter?
Party Affiliation
Do you receive any form of government assistance? (This can include SNAP, SSI-DI, LIHEAP or Section 8) *
Do you feel that you have safe & affordable housing in your community? *
Do you own or rent your home? *
Do you have school age children in your household? *
If you have a school age child in the home, do they attend Public, Charter, or Private School? *
Are you satisfied with the local school and recreational facilities options available to your children in the community? *
How often do you or your children utilize your local recreational center?
Do you feel that your community is safe and meets the health and welfare needs of your family? *
Do you feel you have access to fresh, healthy, affordable foods in your community? *
Do you do most or all of your grocery shopping locally within the following distances *
How often do you go grocery shopping? *
What is your monthly grocery budget?
Which local grocer do you utilize?
Check all of the items that are normally on your grocery list
What would you consider the most pressing concerns in your community? Check all that apply
Would you like to receive information from Community Solutions on programs and services available? *
If you would like to receive information from Community Solutions, please provide your email address
Your answer
If you would like to receive information from Community Solutions but do not have a valid email address, please provide your Name and mailing address
Your answer
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