2016 Community Assessment Survey

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* 1. Check one that best describes your relationship to GROW South Dakota.

I am a GROW SD Client - Please answer each question below based on the needs of your own household.

I am a Partner Organization - Please answer each question below based on the needs of the community you serve.

Other (please specify)

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* 2. What is your gender?

Female

Male

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* 3. What is your age?

14 to 19

20 to 29

30 to 39

40 to 59

60 to 69

70 and over

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* 4. How many people live in your household, including yourself?

6 or more

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* 5. Check one that describes your health care coverage.

Health Insurance Plan at Work

Individual Health Insurance Plan

Medicare/Medicaid

Uninsured

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* 6. Check one that describes your employment status.

Full-time employed

Part-time employed

Self-employed

Unemployed

Retired

Disabled

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* 7. What is your race/ethnicity?

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian

Hispanic or Latino

Two or more races

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* 8. What is your annual income?

$0 - $15,000

$15,001 - $20,000

$20,001 - $25,000

$25,001 - $35,000

$35,001 - $50,000

$50,001 - $70,000

$70,001 or higher

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* 9. Check one that best describes where you live.

I own my Home

I live in a Rental Unit

I live with Family or Friends

I am Homeless

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* 10. Are you a Veteran?

Yes

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* 11. List two things you, your family and friends value most about living in your community:

Item #1

Item#2

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* 12. Enter the name of the County where you reside.

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* 13. Please rank the following needs as they currently apply to your household/community and check the YES box if you received this service from GROW SD in the past three years.

My Household/Community is in Need of…

	High Need	Moderate Need	Not a Need	YES, I received this service from GROW SD
Business Counseling or Training	Business Counseling or Training High Need	Business Counseling or Training Moderate Need	Business Counseling or Training Not a Need	Business Counseling or Training YES, I received this service from GROW SD
Business Loan to Start or Expand a Business	Business Loan to Start or Expand a Business High Need	Business Loan to Start or Expand a Business Moderate Need	Business Loan to Start or Expand a Business Not a Need	Business Loan to Start or Expand a Business YES, I received this service from GROW SD
Child Support Enforcement	Child Support Enforcement High Need	Child Support Enforcement Moderate Need	Child Support Enforcement Not a Need	Child Support Enforcement YES, I received this service from GROW SD
Emergency Assistance – Food, Clothing, Shelter, Utility Assistance	Emergency Assistance – Food, Clothing, Shelter, Utility Assistance High Need	Emergency Assistance – Food, Clothing, Shelter, Utility Assistance Moderate Need	Emergency Assistance – Food, Clothing, Shelter, Utility Assistance Not a Need	Emergency Assistance – Food, Clothing, Shelter, Utility Assistance YES, I received this service from GROW SD
Enrolling in the Affordable Healthcare Insurance Program	Enrolling in the Affordable Healthcare Insurance Program High Need	Enrolling in the Affordable Healthcare Insurance Program Moderate Need	Enrolling in the Affordable Healthcare Insurance Program Not a Need	Enrolling in the Affordable Healthcare Insurance Program YES, I received this service from GROW SD
Financial Coaching - Manage money or repair credit	Financial Coaching - Manage money or repair credit High Need	Financial Coaching - Manage money or repair credit Moderate Need	Financial Coaching - Manage money or repair credit Not a Need	Financial Coaching - Manage money or repair credit YES, I received this service from GROW SD
Home Loans (Mortgage, Down Payment, Closing Cost)	Home Loans (Mortgage, Down Payment, Closing Cost) High Need	Home Loans (Mortgage, Down Payment, Closing Cost) Moderate Need	Home Loans (Mortgage, Down Payment, Closing Cost) Not a Need	Home Loans (Mortgage, Down Payment, Closing Cost) YES, I received this service from GROW SD
Home Improvements	Home Improvements High Need	Home Improvements Moderate Need	Home Improvements Not a Need	Home Improvements YES, I received this service from GROW SD
Homeownership Education	Homeownership Education High Need	Homeownership Education Moderate Need	Homeownership Education Not a Need	Homeownership Education YES, I received this service from GROW SD
Governor’s Homes	Governor’s Homes High Need	Governor’s Homes Moderate Need	Governor’s Homes Not a Need	Governor’s Homes YES, I received this service from GROW SD
Rental Housing or Rental Assistance	Rental Housing or Rental Assistance High Need	Rental Housing or Rental Assistance Moderate Need	Rental Housing or Rental Assistance Not a Need	Rental Housing or Rental Assistance YES, I received this service from GROW SD
Weatherization to Improve Home Energy Efficiency	Weatherization to Improve Home Energy Efficiency High Need	Weatherization to Improve Home Energy Efficiency Moderate Need	Weatherization to Improve Home Energy Efficiency Not a Need	Weatherization to Improve Home Energy Efficiency YES, I received this service from GROW SD
Please list other needs:	Please list other needs: High Need	Please list other needs: Moderate Need	Please list other needs: Not a Need	Please list other needs: YES, I received this service from GROW SD

Other (please specify)

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* 14. For each of the following community assets and services, please rate your level of agreement with this statement:

My community sufficiently provides…

	Agree	Neither Agree or Disagree	Disagree	Not Applicable
A Safe Place to Live	A Safe Place to Live Agree	A Safe Place to Live Neither Agree or Disagree	A Safe Place to Live Disagree	A Safe Place to Live Not Applicable
A Friendly Place to Live	A Friendly Place to Live Agree	A Friendly Place to Live Neither Agree or Disagree	A Friendly Place to Live Disagree	A Friendly Place to Live Not Applicable
Shows Community Pride	Shows Community Pride Agree	Shows Community Pride Neither Agree or Disagree	Shows Community Pride Disagree	Shows Community Pride Not Applicable
Businesses that Meet Our Needs	Businesses that Meet Our Needs Agree	Businesses that Meet Our Needs Neither Agree or Disagree	Businesses that Meet Our Needs Disagree	Businesses that Meet Our Needs Not Applicable
Rental Housing	Rental Housing Agree	Rental Housing Neither Agree or Disagree	Rental Housing Disagree	Rental Housing Not Applicable
Affordable Homes for Purchase	Affordable Homes for Purchase Agree	Affordable Homes for Purchase Neither Agree or Disagree	Affordable Homes for Purchase Disagree	Affordable Homes for Purchase Not Applicable
Jobs/Business Opportunities	Jobs/Business Opportunities Agree	Jobs/Business Opportunities Neither Agree or Disagree	Jobs/Business Opportunities Disagree	Jobs/Business Opportunities Not Applicable
Day Care Services	Day Care Services Agree	Day Care Services Neither Agree or Disagree	Day Care Services Disagree	Day Care Services Not Applicable
Community Education/Training Opportunities	Community Education/Training Opportunities Agree	Community Education/Training Opportunities Neither Agree or Disagree	Community Education/Training Opportunities Disagree	Community Education/Training Opportunities Not Applicable
Please list other assets or services:	Please list other assets or services: Agree	Please list other assets or services: Neither Agree or Disagree	Please list other assets or services: Disagree	Please list other assets or services: Not Applicable

Other (please specify)

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* 15. What do you think is the main cause of poverty in your community? (Select only one)

Lack of jobs

Low motivation or low work ethic

Language or cultural barriers

Lack of quality housing

Obsolete industrial facilities

Poor schools

Low wages

Rural isolation

Drug abuse/addiction

Not enough federal or state investment

Other (please specify)

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* 16. Do you feel you are an active participant in your community?

Yes, definitely

Somewhat

Not at all

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* 17. Compared to three years ago, how would you say the physical condition of housing has changed in your community?

Improved

Stayed about the same

Declined

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* 18. Do you believe that GROW South Dakota programs and services improve the lives of individuals, families and communities?

Yes, definitely

Somewhat

Not at all

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* 19. Did your day-to-day living improve because of assistance you received from GROW South Dakota?

Significantly More

Remained the Same

Significantly Less

Not Applicable

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* 20. How would you rate GROW South Dakota’s service?

Outstanding

Satisfactory

Unsatisfactory

No Opinion

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* 21. Please list any additional comments regarding GROW South Dakota:

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* 22. Contact Information: (optional)

Name

Address

City

State

ZIP

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* 1. Check one that best describes your relationship to GROW South Dakota.

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* 2. What is your gender?

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* 3. What is your age?

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* 4. How many people live in your household, including yourself?

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* 5. Check one that describes your health care coverage.

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* 6. Check one that describes your employment status.

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* 7. What is your race/ethnicity?

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* 8. What is your annual income?

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* 9. Check one that best describes where you live.

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* 10. Are you a Veteran?

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* 11. List two things you, your family and friends value most about living in your community:

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* 12. Enter the name of the County where you reside.

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* 13. Please rank the following needs as they currently apply to your household/community and check the YES box if you received this service from GROW SD in the past three years.My Household/Community is in Need of…

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* 14. For each of the following community assets and services, please rate your level of agreement with this statement:My community sufficiently provides…

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* 15. What do you think is the main cause of poverty in your community? (Select only one)

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* 16. Do you feel you are an active participant in your community?

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* 17. Compared to three years ago, how would you say the physical condition of housing has changed in your community?

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* 18. Do you believe that GROW South Dakota programs and services improve the lives of individuals, families and communities?

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* 19. Did your day-to-day living improve because of assistance you received from GROW South Dakota?

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* 20. How would you rate GROW South Dakota’s service?

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* 21. Please list any additional comments regarding GROW South Dakota:

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* 22. Contact Information: (optional)

* 13. Please rank the following needs as they currently apply to your household/community and check the YES box if you received this service from GROW SD in the past three years.

My Household/Community is in Need of…

* 14. For each of the following community assets and services, please rate your level of agreement with this statement:

My community sufficiently provides…