South Coast LGBTQ Network Community Needs Assessment
The South Coast LGBTQ Network wants to know who makes up their community and what needs they have in order to better serve them. This survey can be filled out on your mobile device, but works best on a laptop, computer or tablet and will take about ten (10) minutes to complete. If you have any questions about this survey please contact the South Coast LGBTQ Network at (774) 371-0711. This survey will end September 1, 2018.
How do you identify your gender identity? *
Required
How do you identify your sexuality? *
Required
Please select if you identify as: *
Required
What is your age bracket? *
How do you racially and ethnically identify? Select all that apply. *
Required
What city/town do you live in? *
Required
*Optional* What was your total household income before taxes during the past 12 months?
What is your relationship status? Select all that apply. *
Required
*Optional* Do you have children?
If yes, please select the ages of all of your children.
*Optional* Please specify if any of your children identify as part of the LGBTQ Community or any other information regarding your children you see as applicable.
Your answer
*Optional* Have you experienced any of the following in the last 24 months? Check all that apply.
Please feel free to describe any housing issues had in the South Coast of Massachusetts. Does not have to be related to LGBTQ identity.
Your answer
If available, would you be interested in being more active at LGBTQ events?
What times would you most often be available to attend events, support groups, or other services? Select all that apply.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Early Morning (Before 8)
Mid Morning (8-11)
Noon (11-2)
Afternoon (2-5)
Evening (5-8)
Late Night (8-2)
What sources do you use to gain information on local events, news and other info? Select all that apply.
Where is the best place for you to see event flyers?
Do you prefer attending events with or without alcohol?
Do you prefer attending events with or without youth/children?
What services and resources would you like to have access to? Select all that apply.
What type of support groups would you be interested in attending? Select all that apply.
Do you feel that New Bedford and the South Coast region are LGBTQ inclusive?
Please state why you chose the answer above.
Your answer
What LGBTQ events would you like to see in the South Coast Region? Select all that apply.
*Optional* How do you cope with stress? Select all that apply.
*Optional* Do you feel safe being out as LGBTQ in your community?
Please explain why.
Your answer
Of the following, with which do you feel support from or safe with? Please select all that apply.
Please explain.
Your answer
Do you feel support from or safe in your workplace?
Please explain.
Your answer
Do you feel support from or safe in your current living situation?
Please explain.
Your answer
*Optional* Have you experienced any of these? Select all that apply.
If you have selected any above, have you looked or tried to access services to receive help or support? If so, where you able to get help? Where your experiences both in the abuse or in trying to access services to help effected by your LGBTQ identity? Please explain.
Your answer
*Optional* In regards to practicing safer sex, what do you need access to? Select all that apply.
*Optional* What medical services would you like to access to support yourself as an LGBTQ identified individual or family? Select all that apply.
For those over 50 years of age, would you feel comfortable going to elder housing if needed, now or in the future? Please rate on a scale from 1 to 5.
Not at all comfortable
Very Comfortable
Please explain your rating above and in what way your identity in the LGBT community plays a role. In addition, please list any things you feel are missing or any additional needs you have that are not being fulfilled by the housing facility.
Your answer
Thank you for completing this survey! If you have any further questions, comments, or concerns, please list them here. This includes, but is not limited to, any resources you are looking for, any specific activities you would like to see happen, or any other needs that the South Coast LGBTQ Network can help with.
Your answer
**OPTIONAL** If you would like to be contacted in the future, in regards to this survey or any future events, please provide your contact information and the best way to reach you, including name, phone number, email and/or mailing address.
Your answer
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