LONAQ

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LONAQ

Level 1 Needs Assessment Questionnaire

Email *

In the last six months, have you had a need for food? *

Yes

What is your gender *

Female

Male

In the last six months, have you had a need for shelter or to be housed? *

Yes

In the last six months, did you have a need for air?

Yes

Clear selection

In the last six months, have you had a need for clothing to wear outdoors? *

Yes

Enter your Age *

In the last six months, have you had a need for water? *

Yes

How much Education have you completed so far? *

Graduated from Elementary School

Graduated from High School

Graduated from College

I have not Graduated from Elementary School or Adult Basic Education

In the last six months, have you had a need for heat where you are housed? *

Yes

In the last six months, have you had a need for friendship or companionship? *

Yes

In the last six months, have you had a need for sleep for at least 4 hours per night? *

Yes

Submit

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