2026 Community Needs Survey

1
Which county do you live in?* This field is required.
Herkimer
Madison
Oneida
Other
2
How many people live in your home?* This field is required.
3
Family of 1: Is your annual income (total gross income received by all household members) above or below $15, 960?* This field is required.
Above
Below
4
Family of 2: Is your annual income (total gross income received by all household members) above or below $21, 640?* This field is required.
Above
Below
5
Family of 3: Is your annual income (total gross income received by all household members) above or below $27, 320?* This field is required.
Above
Below
6
Family of 4: Is your annual income (total gross income received by all household members) above or below $33, 000?* This field is required.
Above
Below
7
Family of 5: Is your annual income (total gross income received by all household members) above or below $38, 680?* This field is required.
Above
Below
8
Family of 6: Is your annual income (total gross income received by all household members) above or below $44, 360?* This field is required.
Above
Below
9
Family of 7: Is your annual income (total gross income received by all household members) above or below $50, 040?* This field is required.
Above
Below
10
Family of 8: Is your annual income (total gross income received by all household members) above or below $55, 720?* This field is required.
Above
Below
11
Family of 9: Is your annual income (total gross income received by all household members) above or below $61, 400?* This field is required.
Above
Below
12
Family of 10: Is your annual income (total gross income received by all household members) above or below $67, 080?* This field is required.
Above
Below
13
Family of 11: Is your annual income (total gross income received by all household members) above or below $72, 760?* This field is required.
Above
Below
14
Family of 12: Is your annual income (total gross income received by all household members) above or below $78, 440?* This field is required.
Above
Below
15
Family of 13: Is your annual income (total gross income received by all household members) above or below $84, 120?* This field is required.
Above
Below
16
Family of 14: Is your annual income (total gross income received by all household members) above or below $89, 800?* This field is required.
Above
Below
17
Family of 15+: Is your annual income (total gross income received by all household members) above or below $95, 480?* This field is required.
Above
Below
18
Family of 1: Is your annual income (total gross income received by all household members) above or below $31,920?* This field is required.
Above
Below
19
Family of 2: Is your annual income (total gross income received by all household members) above or below $43,280?* This field is required.
Above
Below
20
Family of 3: Is your annual income (total gross income received by all household members) above or below $54,640?* This field is required.
Above
Below
21
Family of 4: Is your annual income (total gross income received by all household members) above or below $66,000?* This field is required.
Above
Below
22
Family of 5: Is your annual income (total gross income received by all household members) above or below $77,360?* This field is required.
Above
Below
23
Family of 6: Is your annual income (total gross income received by all household members) above or below 88,720?* This field is required.
Above
Below
24
Family of 7: Is your annual income (total gross income received by all household members) above or below 100,080?* This field is required.
Above
Below
25
Family of 8: Is your annual income (total gross income received by all household members) above or below $111,440?* This field is required.
Above
Below
26
Family of 9: Is your annual income (total gross income received by all household members) above or below 122,800?* This field is required.
Above
Below
27
Family of 10: Is your annual income (total gross income received by all household members) above or below $134,160?* This field is required.
Above
Below
28
Family of 11: Is your annual income (total gross income received by all household members) above or below $145,520?* This field is required.
Above
Below
29
Family of 12: Is your annual income (total gross income received by all household members) above or below $156,880?* This field is required.
Above
Below
30
Family of 13: Is your annual income (total gross income received by all household members) above or below $168,240?* This field is required.
Above
Below
31
Family of 14: Is your annual income (total gross income received by all household members) above or below 179,600?* This field is required.
Above
Below
32
Family of 15+: Is your annual income (total gross income received by all household members) above or below $190,960?* This field is required.
Above
Below
33
Over the past 12 months, how often did you struggle to...* This field is required.(Scroll down to answer all questions)
Never
Rarely
Often
Always
Pay for essential goods (ex. food, toiletries) consistently?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Pay bills on time?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Save money for the future?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Pay for essential goods (ex. food, toiletries) consistently?
Pay bills on time?
Save money for the future?
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Often
Row 2, Column 2
Always
Row 2, Column 3
1 of 3
34
How confident are you in...* This field is required.(Scroll down to answer all questions)
Not confident at all
Somewhat confident
Mostly confident
Very confident
Your ability to properly budget your money?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Your understanding of your credit score and the way it impacts you?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Your understanding of how to improve your credit score?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Your ability to properly budget your money?
Your understanding of your credit score and the way it impacts you?
Your understanding of how to improve your credit score?
Not confident at all
Row 0, Column 0
Somewhat confident
Row 0, Column 1
Mostly confident
Row 0, Column 2
Very confident
Row 0, Column 3
Not confident at all
Row 1, Column 0
Somewhat confident
Row 1, Column 1
Mostly confident
Row 1, Column 2
Very confident
Row 1, Column 3
Not confident at all
Row 2, Column 0
Somewhat confident
Row 2, Column 1
Mostly confident
Row 2, Column 2
Very confident
Row 2, Column 3
1 of 3
35
Do you have access to a bank account?* This field is required.
Yes, consistently
Only sometimes
No
36
Are you facing any other financial challenges (that you would like us to know about?)
37
What is your current housing status?* This field is required.
Rent
Own
Other permanent housing
Homesless
Other
38
Over the past 12 months, how often did you struggle to...* This field is required.(Scroll down to answer all questions)
Never
Rarely
Often
Always
N/A
Access safe shelter?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Afford utilities (eg. heat, electric, water, plumbing)?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Get necessary home repairs completed?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Feel safe in your home because of the threat of crime?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Feel safe in your home because of the threat of violence?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Access safe shelter?
Afford utilities (eg. heat, electric, water, plumbing)?
Get necessary home repairs completed?
Feel safe in your home because of the threat of crime?
Feel safe in your home because of the threat of violence?
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
N/A
Row 0, Column 4
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
N/A
Row 1, Column 4
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Often
Row 2, Column 2
Always
Row 2, Column 3
N/A
Row 2, Column 4
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Often
Row 3, Column 2
Always
Row 3, Column 3
N/A
Row 3, Column 4
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Often
Row 4, Column 2
Always
Row 4, Column 3
N/A
Row 4, Column 4
1 of 5
39
Are you able to live independently?* This field is required.
Yes, easily
Yes, but it is difficult for me
No
40
Would you be willing to tell us why you cannot/struggle to live independently THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
41
Over the past 12 months, how often did you struggle to pay your rent/mortgage on time?* This field is required.
Never
Rarely
Often
Always
Don't pay rent/mortgage
42
Have you ever been evicted?* This field is required.
No
Yes, once or twice
Yes, many times
43
Has your home been tested for these substances, and if so, what was the result?* This field is required.(Scroll down to answer all questions)
Tested positive, has been taken care of
Tested positive, has not been taken care of
Tested negative
Have not tested for this substence
Unknown
Radon (a natural gas, can be found anywhere in the home but often comes from basements and crawl spaces)
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Lead (often found in paint or plumbing systems in homes built before 1978)
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Asbestos (often found in the insulation, ceilings, and dry wall of homes built before 1980)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Radon (a natural gas, can be found anywhere in the home but often comes from basements and crawl spaces)
Lead (often found in paint or plumbing systems in homes built before 1978)
Asbestos (often found in the insulation, ceilings, and dry wall of homes built before 1980)
Tested positive, has been taken care of
Row 0, Column 0
Tested positive, has not been taken care of
Row 0, Column 1
Tested negative
Row 0, Column 2
Have not tested for this substence
Row 0, Column 3
Unknown
Row 0, Column 4
Tested positive, has been taken care of
Row 1, Column 0
Tested positive, has not been taken care of
Row 1, Column 1
Tested negative
Row 1, Column 2
Have not tested for this substence
Row 1, Column 3
Unknown
Row 1, Column 4
Tested positive, has been taken care of
Row 2, Column 0
Tested positive, has not been taken care of
Row 2, Column 1
Tested negative
Row 2, Column 2
Have not tested for this substence
Row 2, Column 3
Unknown
Row 2, Column 4
1 of 3
44
Are you facing any other housing challenges?
45
What is your current work status? (Check all that apply)* This field is required.
Working (Full-time)
Working (Part-time)
Working (Temporary)
Working (Multiple Jobs)
Self-Employed
Unemployed
Student
46
What are the reasons for your unemployment? (Check all that apply)* This field is required.
Unable to find a job in preferred field
Busy caring for children (personal choice)
Busy caring for children (can’t afford childcare)
No access to transportation
Do not speak or read English
Do not have required materials for work (driver's license, working papers, etc)
Worried about losing benefits if income increases
Unable to find a job that is family-friendly/allows for a work-life balance
Unable to find a job that pays enough to get by
Criminal record makes it difficult to find work
Lack of education/experience
Retired
Other
47
Did your previous job pay enough for you to get by?* This field is required.
Yes
No
I have never held a job in the U.S.
48
How difficult is/was it for you to obtain the necessary requirements to work? (ex: driver’s license, working papers, etc)* This field is required.
Not difficult
Slightly difficult
Moderately difficult
Very difficult
49
Does your job pay you enough to get by?* This field is required.
YESNO
50
Do you have multiple jobs?* This field is required.
YESNO
51
Do you have a criminal record?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
YESNO
52
Did it negatively impact your ability to find work?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
YESNO
53
Over the past 12 months, how often did you struggle to…* This field is required.
Never
Rarely
Often
Always
Access reliable transportation to and from work?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Maintain a reasonable work-life balance?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Access reliable transportation to and from work?
Maintain a reasonable work-life balance?
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
1 of 2
54
How difficult is/was it to receive the education needed for the job you want?* This field is required.
Not difficult
Slightly difficult
Moderately difficult
Very difficult
55
Are you working the job you want?* This field is required.
YESNO
56
Are you facing any other employment challenges?
57
Over the past 12 months, how often have you struggled with your...* This field is required.
Never
Rarely
Often
Always
Mental Health
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Physical Health
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Mental Health
Physical Health
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
1 of 2
58
How confident are you in your ability to navigate the US healthcare system?* This field is required.
Not confident at all
Somewhat confident
Mostly confident
Very confident
59
Do you have a diagnosis related to your mental health?* This field is required.
YESNO
60
Do you have a diagnosis related to your physical health?* This field is required.
YESNO
61
Over the past 12 months, how often have you struggled to...* This field is required.(Scroll down to answer all questions)
Never
Rarely
Often
Always
This is not relevant to me
Afford reliable health insurance that covers your/your family's needs
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Access a primary care doctor
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Access a medical specialist
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Access a dentist
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Access mental health care
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Access treatment for substance abuse/addiction
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Access vaccines or immunizations
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Afford reliable health insurance that covers your/your family's needs
Access a primary care doctor
Access a medical specialist
Access a dentist
Access mental health care
Access treatment for substance abuse/addiction
Access vaccines or immunizations
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
This is not relevant to me
Row 0, Column 4
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
This is not relevant to me
Row 1, Column 4
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Often
Row 2, Column 2
Always
Row 2, Column 3
This is not relevant to me
Row 2, Column 4
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Often
Row 3, Column 2
Always
Row 3, Column 3
This is not relevant to me
Row 3, Column 4
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Often
Row 4, Column 2
Always
Row 4, Column 3
This is not relevant to me
Row 4, Column 4
Never
Row 5, Column 0
Rarely
Row 5, Column 1
Often
Row 5, Column 2
Always
Row 5, Column 3
This is not relevant to me
Row 5, Column 4
Never
Row 6, Column 0
Rarely
Row 6, Column 1
Often
Row 6, Column 2
Always
Row 6, Column 3
This is not relevant to me
Row 6, Column 4
1 of 7
62
How easy is it for you to...* This field is required.(Scroll down to answer all questions)
Very easy
Somewhat easy
Difficult
Very Difficult
This is not relevant to me
Pay medical bills
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Pay for prescription medications
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Pay medical bills
Pay for prescription medications
Very easy
Row 0, Column 0
Somewhat easy
Row 0, Column 1
Difficult
Row 0, Column 2
Very Difficult
Row 0, Column 3
This is not relevant to me
Row 0, Column 4
Very easy
Row 1, Column 0
Somewhat easy
Row 1, Column 1
Difficult
Row 1, Column 2
Very Difficult
Row 1, Column 3
This is not relevant to me
Row 1, Column 4
1 of 2
63
Are you facing any other specific challenges in regards to your health?
64
Do you have (or are you the primary caregiver for) children?* This field is required.
YESNO
65
Are you the parent (or caregiver) of a child...* This field is required.Select all that apply
Under 5 years old
5-17 years old
66
Over the past 12 months, how often did you struggle to...* This field is required.(Scroll down to answer all questions)
Never
Rarely
Often
Always
This is not relevant to my child
Find child care, specifically during your work hours
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Find child care, in general
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Afford child care
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Access transportation to and from child care
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Obtain supportive services for your child?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Find child care, specifically during your work hours
Find child care, in general
Afford child care
Access transportation to and from child care
Obtain supportive services for your child?
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
This is not relevant to my child
Row 0, Column 4
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
This is not relevant to my child
Row 1, Column 4
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Often
Row 2, Column 2
Always
Row 2, Column 3
This is not relevant to my child
Row 2, Column 4
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Often
Row 3, Column 2
Always
Row 3, Column 3
This is not relevant to my child
Row 3, Column 4
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Often
Row 4, Column 2
Always
Row 4, Column 3
This is not relevant to my child
Row 4, Column 4
1 of 5
67
Child 5-17: In the past 12 months, how often did you struggle to...* This field is required.(Scroll down to answer all questions)
Never
Rarely
Often
Always
This is not relevant to my child
Access resources to help your child succeed in school
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Find transportation to and from school
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Pay for expenses related to your child's education
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Access resources to help your child succeed in school
Find transportation to and from school
Pay for expenses related to your child's education
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
This is not relevant to my child
Row 0, Column 4
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
This is not relevant to my child
Row 1, Column 4
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Often
Row 2, Column 2
Always
Row 2, Column 3
This is not relevant to my child
Row 2, Column 4
1 of 3
68
Child 5-17: Do you...* This field is required.
Yes
Somewhat
No
This is not relevant to my child
Understand how to help your child access education after high school
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Struggle to save for your child's education in the future?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Understand how to help your child access education after high school
Struggle to save for your child's education in the future?
Yes
Row 0, Column 0
Somewhat
Row 0, Column 1
No
Row 0, Column 2
This is not relevant to my child
Row 0, Column 3
Yes
Row 1, Column 0
Somewhat
Row 1, Column 1
No
Row 1, Column 2
This is not relevant to my child
Row 1, Column 3
1 of 2
69
What level of education do you have?* This field is required.Select the highest level of which you have received
Please Select
Didn't attend school
8th grade or less
Some high school
High school diploma (Graduated)
GED
Some college
Associates' degree
Bachelor's degree
Master's Degree
Doctoral degree
Trade school
Professional certification
Other
70
Would you know how to access adult education options (ex. GED), if need be?* This field is required.
YESNO
71
Do/did you struggle with affording higher, adult education (ex. college)?* This field is required.
YESNO
72
Are you impacted by student loan debt?* This field is required.
YESNO
73
Over the past 12 months, how often have you struggled to...* This field is required.(Scroll down to answer all questions)
Never
Rarely
Often
Always
This is not relevant to me
Access reliable internet and cell phone service
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Access safe, recreational spaces
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Access safe, green spaces (ex: parks)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Access public social service/welfare programs
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Involve yourself with community groups
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Participate in civic events
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Feel safe because of the threat of crime or violence in the community
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Access reliable internet and cell phone service
Access safe, recreational spaces
Access safe, green spaces (ex: parks)
Access public social service/welfare programs
Involve yourself with community groups
Participate in civic events
Feel safe because of the threat of crime or violence in the community
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Often
Row 0, Column 2
Always
Row 0, Column 3
This is not relevant to me
Row 0, Column 4
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Often
Row 1, Column 2
Always
Row 1, Column 3
This is not relevant to me
Row 1, Column 4
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Often
Row 2, Column 2
Always
Row 2, Column 3
This is not relevant to me
Row 2, Column 4
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Often
Row 3, Column 2
Always
Row 3, Column 3
This is not relevant to me
Row 3, Column 4
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Often
Row 4, Column 2
Always
Row 4, Column 3
This is not relevant to me
Row 4, Column 4
Never
Row 5, Column 0
Rarely
Row 5, Column 1
Often
Row 5, Column 2
Always
Row 5, Column 3
This is not relevant to me
Row 5, Column 4
Never
Row 6, Column 0
Rarely
Row 6, Column 1
Often
Row 6, Column 2
Always
Row 6, Column 3
This is not relevant to me
Row 6, Column 4
1 of 7
74
Are you able to access immigration, refugee, and New American Services when you need them?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
Yes
No
I do not require these services
75
Are there any resources or opportunities you wish were available in your community but aren't?
76
Have you ever experienced discrimination due to any of these factors? (Check all that apply)THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
Race/ethnicity
Gender identity
Sexual orientation
I have not experienced discrimination
77
In which areas of life have you experienced this discrimination?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS (Select all that apply)
Financial
Housing
Employment
Education
Health Care
Mental Health Care
In My Community
Interpersonal Interaction
Prefer Not to Say
Other
78
Would you be willing to share your experience with us to help us better understand?All questions on this survey are completely anonymous
79
Please select the THREE areas where your family currently needs the MOST support:* This field is required.(Scroll down to view all options)
Employment
Financial Support
Housing
Education
Health Care
Food and Nutrition
Mental Health Care
Transportation
Internet Access
Child Care
Safety/Violence Prevention
Support for Addiction
Not Applicable
80
Are there any other areas of life in which your family could use support?
81
Please list any organizations who have helped your family in the past, or who are helping you now.
82
Do you currently receive any of the following assistance:
Supplemental Security Income (SSI)
Social Security Disability Insurance (SSDI)
Temporary Assistance (TA) (formerly known as Public Assistance)
Supplemental Nutrition Assistance Program (SNAP)
Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC)
Medicaid
Home Energy Assistance Program (HEAP)
Other
83
Have you received any services from the Mohawk Valley Community Action Agency (MVCAA) before?* This field is required.
YESNO
84
How old are you?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
85
How would you describe your gender?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
Female
Male
Transgender Female
Transgender Male
Non-binary/Gender Non-Conforming
Prefer Not to State
Other
86
How would you describe your race and/or ethnicity?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
White
Black / African American
Native American / Alaskan Native
Asian
Hispanic / Latino
Native Hawaiian / Pacific Islander
Middle Eastern / North African (MENA)
Multiracial / Biracial
Prefer not to say
Other
87
What is your primary language?THIS QUESTION IS OPTIONAL AND ALL ANSWERS ARE ANONYMOUS
88
Please verify that you are human* This field is required.
Should be Empty: