2009 CSBG NEEDS ASSESSMENT SURVEY!

(Please help us by giving us your valuable opinions.)

Please check any of the following you

feel are needed in our communities.

PLEASE CLICK ON THE SUBMIT BUTTON AT THE END OF THE SURVEY!

This page was last updated: May 4, 2010

NAME: (Optional)__________________ County__________________________ Date:___________________________

Please tell us how you know us:

Please list what you consider the three most pressing community needs in Auglaize and Mercer counties:

Assistance with utilities and heating needs, including shut-off notices

Assistance with furnace and water heater repairs and weatherization

Assistance with transportation to work

Assistance with transportation to medical appointments

Assistance with prescription medications and medical needs

Assistance with food

Assistance with rent or mortgage payments to prevent evictions

Assistance with home repairs

Assistance with employment related needs (work boots, etc.)

Are there other needs, not previously mentioned, you feel require or need more community attention?  If so, please describe:

Please tell us how the economic downturn has affected you:

Please tell us how we may better serve you and the community:

COMMENTS:

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