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