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2014
February
M
Milton-Freewater Community Survey
Milton-Freewater Community Survey
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Hello:
You are invited to participate in our survey Milton-Freewater Community Health Survey. In this survey people will be asked to complete a survey that asks questions about the community needs, resources and gaps. It will take approximately 10 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Nora Kramer at (541)938-0282 or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
What are your major concerns in your community? Please mark them:
Community Safety
Education
Health
Nutrition needs
Domestic violence
Drugs/Substances abuse
Transportation
Mental health
Social problems
Other
Please describe those major community concerns:
Please describe the community resources/agencies from whom you receive services to meet yours and your family needs. These could include employment agencies, healthcare agencies, childcare, social services, and government agencies.
Please rank (1-12) the following in order of interest:
Safe Kids
-- Select --
1
2
3
4
5
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7
8
9
10
11
12
Drug/Alcohol
-- Select --
1
2
3
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5
6
7
8
9
10
11
12
Tobacco
-- Select --
1
2
3
4
5
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7
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9
10
11
12
Obesity
-- Select --
1
2
3
4
5
6
7
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9
10
11
12
Children Health
-- Select --
1
2
3
4
5
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7
8
9
10
11
12
Seniors Health
-- Select --
1
2
3
4
5
6
7
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10
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12
Mental Health
-- Select --
1
2
3
4
5
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7
8
9
10
11
12
Child care
-- Select --
1
2
3
4
5
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7
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9
10
11
12
Job security
-- Select --
1
2
3
4
5
6
7
8
9
10
11
12
Feeding your family
-- Select --
1
2
3
4
5
6
7
8
9
10
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12
Housing
-- Select --
1
2
3
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5
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7
8
9
10
11
12
Recreational activities
-- Select --
1
2
3
4
5
6
7
8
9
10
11
12
What are the greatest strengths and potential gaps in your community?
Thank you very much for your valuable feedback!
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