Needs Assessment Questionnaire
The LGBTQ+ Center Lake County is an open and affirming environment for people of all sexual orientations and gender identities. We provide support, education, resources, and advocacy to achieve a stronger and healthier world for LGBTQIA+ people and allies.
Your answers to this survey will provide necessary feedback about services, events and activities you’d be interested in, and will help to shape the Center’s role in the community.
***All personal information collected will remain confidential***
* Required
Age
*
Your answer
City, ZIP
*
Your answer
Sex Assigned at Birth
*
Male
Female
Intersex
Gender (choose all that apply)
*
Woman
Man
Trans woman
Trans man
Nonbinary/Genderqueer/Gender non-conforming
My gender is not listed here
Prefer not to say
Required
Sexual Orientation (choose all that apply)
*
Lesbian
Gay
Bisexual
Queer
Heterosexual
Pansexual
Questioning
Asexual
My sexuality is not listed here
Prefer not to say
Required
Race
*
Native American or Alaskan Native
Native Hawaiian or other Pacific Islander
Asian
Black/African American
White
Multi-racial
Prefer not to say
My race is not listed here
Do you identify as Hispanic or Latinx?
*
Yes
No
Prefer not to say
Before today, had you heard of the LGBTQ+ Center of Lake County?
*
Yes
No
Would you visit the LGBTQ+ Center Lake County?
*
Yes
No
How many miles would you be willing to travel to visit a Center?
*
Choose
1-5 miles
6-10 miles
11-20 miles
more than 20 miles
How important do you think it is to have an LGBTQ+ Center serving Lake County?
*
Very important
Somewhat important
Not important
Don't know
What services would you want to see offered at the Center?
*
Your answer
What do you think are the 3 most important services that should be offered at the Center?
*
Youth after school programs
Support groups
LGBTQ+ awareness training for businesses and organizations
Elder programs
Advocacy for people/policies in the community
Social events (ex. a happy hour)
Educational events (ex. a panel discussion or a documentary film)
Peer to peer counseling onsite
Food bank
LGBTQ+ youth shelter
Elder housing
Transgender specific support
Annual gala event
Pride Prom
LGBTQ+ Business networking
Required
Are you interested in meeting other local LGBTQ+ people?
*
Yes
No
Maybe
What are your main interests?
*
Music
Theatre
Dancing/Clubs
Spirituality
Book clubs
Restaurants/Dining out
Sports
Art
Board games/video games
LGBTQ+ events (social, educational, networking)
Required
What online/virtual services would you like to see offered?
*
Your answer
What concerns do you have about living in Lake County as an LGBTQ+ person?
*
Your answer
How satisfied are you with the existing resources for the LGBTQ+ community in Lake County?
*
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Would you be interested in receiving information about volunteer opportunities?
*
Yes
No
Would you like to be on our contact list? (if yes, list email address)
*
Your answer
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