| Q1 |
What is your City?
|
|
|
|
| Q2 |
What is your County ?
|
|
|
|
| Q3 |
What is your Zip Code ?
|
|
|
|
|
|
| Q5 |
What is your ethnicity ?
|
|
|
|
|
|
| Q7 |
What is your highest level of education completed ?
|
|
|
|
| Q8 |
What best describes your household ?
|
|
|
|
| Q9 |
WRITE IN THE NUMBER of persons for each age group in your household.
|
|
|
|
| Q10 |
What is the primary language spoken in the home ?
|
|
|
|
| Q11 |
Is anyone in your household a veteran ?
|
|
|
|
| Q12 |
Anyone in your household receive disability benefits?
|
|
|
|
| Q13 |
What was your total household income last year?
|
|
|
|
| Q14 |
Mark the choice that best describes you:
|
|
|
|
| Q15 |
What are the MOST Important program/services you would like to see continued in you community?
|
|
|
|
| Q16 |
How much does each item rate as a need in your community?
|
|
|
|