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ROSS Program Community Needs Assessment Survey

Household Information

Are you an adult 18 or older?
Are you the head of household?
Does anyone in your household have a physical or mental disability?

Community/Household Needs

How would you rate the following issues for your household?

Availability of job training opportunities:
Availability of jobs for adults:
Availability of jobs for youth:
Education:
Availability of affordable, reliable child-care services:
Lack of Computer/Digital Literacy:
Lack of affordable Internet service:
Cost of Living:
Income/Wages:
Debt:
Financial Security:
Availability of Financial Services:
Availability of Financial Counseling:
Elderly Living Assistance (62+):
Availability of Health Care:
Physical Health of Residents:
Mental Health of Residents:
Seeking Employment with a Criminal Record:
Obtaining a Degree/Diploma with a Criminal Record:
Substance Abuse Services:
Substance Abuse Treatment:

What are the things that make it difficult for you or other adults in your household to find and/or keep work? (Check all that apply)
Do you or any others in your household have interest in the following? (Check all that apply)
Do you our another adult in your household have difficulty with any of the following? (Check all that apply)
What are the primary health care needs of your household? (Check all that apply)
What is your Gender?
What is your age?