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Northeast Oklahoma CAA

856 E Melton Drive, Suite C, PO Box 603
Jay, OK 74346
http:\\www.neocaa.org

Community Needs Assessment Survey

Q1 What is your City?
    
Q2 What is your County ?
    
Q3 What is your Zip Code ?
    
Q4 What is your gender ?


Q5 What is your ethnicity ?


Q6 What is your race ?






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.
0-2
3-4
5-9
10-14
15-17
18-19
20-24
25-34
35-44
45-54
55-59
60-64
65-74
75-84
85 and Older
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?
If yes, please mark # of each below:
   # of Children     # of Adults
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 your community?
Q16 How much does each item rate as a need in your community?
NUTRITION
No Need Some Need Great Need Don't Know
      Availability/access to food (grocery store)
      Community Gardens
      Nutrition Education/ Healthy Eating
      Need food
EMPLOYMENT
No Need Some Need Great Need Don't Know
      Job Training
      Help finding a job
      Higher Paying Jobs or Jobs with Benefits
HEALTH
No Need Some Need Great Need Don't Know
      Health Insurance/ Affordable Health Care
      Health Education Services
      Mental Health Services
      Substance Abuse Counseling/Treatment
      RX (prescription assistance)
      Child Immunizations
      Teenage Pregnancy/ Family Planning
      Elder Care
      Vision
      Dental Insurance/ Affordable Dental
LINKAGES
No Need Some Need Great Need Don't Know
      Prisoner Discharge Services
      Public Transportation
      Vehicle Repair Assistance
      Access to Services (WIC, SNAP, SSI, Sooner Care)
INCOME MANAGMENT
No Need Some Need Great Need Don't Know
      Free Income Tax Preparation Assistance
      Gambling Counseling
      Budget/Credit/Debit Counseling
EDUCATION
No Need Some Need Great Need Don't Know
      Early Childhood Education Programs
      GED Classes
      English as a Second-Language Classes
      Computer Skills Training
      Literacy Classes
      Technical and Vocational Training
      Childcare
HOUSING
No Need Some Need Great Need Don't Know
      Decent affordable houses to RENT
      Decent affordable houses to BUY
      Weatherization (Home Energy Improvement)
      Home Repair
      Home Buyer Education
      Handicap Accessibility Housing
      Senior Citizens Housing
      Rental Assistance
      Utility Assistance
COMMUNITY
No Need Some Need Great Need Don't Know
      Safe Neighborhoods, sidewalks, parks
      Homeless Shelter
      Senior Activities
      Recreational Activities
      Youth Activities
      Crime Prevention
      Additional Health Care Facilities (Doctor’s Offices, Clinics, Pharmacies)
      Legal Assistance
      Volunteer Opportunities