CHP Survey 2019

Welcome to your CHP Survey 2019

You will be automatically entered for a $200 prize drawing! Please limit one completed survey per household.

Name Email Phone Number

1. What do you feel is the most important service CHP offers to your household?

Foodbank and nutritional assistance Medical and Dental care Financial assistance (Rent, utility) Baby and infant needs Clothing and personal items

2. Please list the ages of all household members.

3. What is your annual household income (Confidential).

Under $10,000 a year

$10,000-$15,000 a year

$15,000-$20,000 a year

$20,000-$30,000 a year

$30,000-$50,000 a year

Greater than $50,000 a year

4. Will you anticipate needing services from The Community Helping Place soon or within the next couple of months?

Yes

5. Based on the picture of Lumpkin county, what zone do you live in?

6. Do you have a “healthcare home” – a place you go first to seek medical care?

YES

7. Do all of the adults living in your home have health insurance?

YES

8. Did our website help you find helpful resources (healthcare, food pantry, financial assistance)?

YES

9. Do you or anyone in your home need transportation to a partner agency in order to receive services?

YES

10. If a local church or faith based organization in your community was willing to provide transportation to our partner agencies, would you accept a ride?

YES

11. Do our events increase community fellowship and connections?

YES

12. Do you have a support system (extended family, neighbors, friends) that you can call if you have an emergency or in the event of a pressing family need?

YES

13. Are you a member of a church, faith-based, or religion based congregation?

YES

14. Would you like us to send you additional information on our community services?

Yes