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2009 Family Survey
In order to continue to provide services to you and others, we need to hear from you! Every three years, NEMCSA Head Start/Early Head Start seeks input from people in the communities we serve about their needs and the needs of others in the area. We use the information to continue programming now in place; to develop new programming as needs indicate; to coordinate services with other human service agencies; and to advocate for funding and legislation for the future.
Survey

1.
What county do you live in?
Alcona
Alpena
Arenac
Bay
Cheboygan
Clare
Crawford
Gladwin
Huron
Iosco
Lapeer
Mecosta
Midland
Montmorency
Ogemaw
Osceola
Oscoda
Otsego
Presque Isle
Sanilac
Tuscola

2.
What is your five digit zip code?

3.
What is your age?
18-24
25-35
36-49
50-59
60-75
76+

4.
Number of people in your home/household (including yourself):
One
Two
Three
Four
Five
Six or more

5.
Are you a single parent with children less than 18 years old at home?
yes
no

6.
How many children do you have between the ages of zero and four?
zero
one
two
three
four
five
six
seven or more

7.
What is your marital status?
Single
Married
Separated
Divorced
Widowed

8.
What is your gender?
Female
Male

9.
Housing:
(Select all that apply.)
I own my own home.
I rent my home.
I live with my children, parent(s) or other family.
I live with my friend(s).
I am homeless.
sleep at night?:

10.
Ethnicity
Hispanic or Latino
Not Hispanic or Latino

11.
Race
White
Black or African American
American Indian or Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander
Bi-Racial/Multi-Racial

12.
Household Income
$0 - 10,210
$10,211 - 13,690
$13,691 - 17,170
$17,171 - 20,690
$20,691 - 24,130
$24,131 - 30,000
$30,001 - $40,000
$40,001 - 50,000
$50,001 - 60,000
$60,001 - 75,000
$75,001 - $100,000
$100,001 or more

13.
Check all sources of income.
(Select all that apply.)
wages (full time)
Wages (part time)
Self-Employment
Social Security
Other Pensions
Investments
Supplemental Security Income (SSI)
Disability Pension/Workers Comp
Public Assistance (DHS)
Stipends
Child Support
Unemployment Benefits

14.
What are the three most important concerns right now for you, your family and others in your community?
(Select all that apply.)
A Place to Live
Affordable Rental Housing
Reliable Transportation
Help Paying Utility Bills
Prescription Drug Assistance
Affordable Child Care
GED or Other Adult Education
Affordable Preschool
Home Health Care
Help with Drug or Alcohol Problems
Mental Health/Counseling Services
Food Assistance
Medical Services
Hospital Services
A Job
Job Training
Dental Care
Spousal Abuse
Child Abuse
Nursing Home Care
Adult Foster Care or Assisted Living
Affordable Recreational Activities
Other -identify:

15.
What do you think are the three greatest strengths of your community?
(Select all that apply.)
Community Spirit/Group Involvement/Service Clubs
Religious Involvement/\Church
Neighborhood Involvement
Family Togetherness
Safety (low crime rates, good protection, etc.)
Good Schools/School Involvement
Public Services (police, fire, sewer/water, etc.)
Social Support Networks
Transportation
Social/Human Service Agency Services
Available, Affordable Child Care
Affordable Housing Opportunities
Employment Opportunities
Medical Care
Dental Care
Recreational Opportunities
Other -identify:

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