Ontario County Community Needs Assessment Survey:
1. Which school district area population does your organization work with? (Circle all which apply)
Phelps-Clifton Springs Geneva Canandaigua Honeoye Bloomfield Gorham-Middlesex Naples Victor
Manchester-Shortsville
2. What service field does your organization primarily concern itself with? (Circle all which apply)
Health/Medicine Services Pre-School/Kindergarten Elementary Middle/High School Job/Vocational Training Higher Education Preparation Disaster Preparedness/Prevention
3. What are the primary groups which your organization serves? (Circle all which apply)
Children Adults Families with Children Schools (teachers, administrators, etc.) Other
4. What age groups does your organization commonly serve in your community? (Circle all which apply)
Birth-5 6-12 13-17 18-25 26-32 33-38 39-44 45-50 51-57 58-64 65+
5. Who is usually the head of the households your organization assist? (Circle one)
Single Mothers Single Fathers Mother/Father (Married/Partnered) Mother/Father (Separated) Grandparents Other
6. What is the race of the groups your organization commonly serves? (Circle all which apply)
African-American White/non-Hispanic Biracial Asian Hispanic Other
7. How many people does your organization serve per year? (Circle one) Yes No
Less than 5,000 5,001-10,000 10,001-15,000 15,001-20,000 20,001-25,000 25,001+
8. Does your organization provide information furthering employment, higher education or job training of Ontario County residents? (Circle One) Yes No
*If “Yes” how many people do you serve regarding employment/higher education/job training? (Circle one)
1-499 500-999 1,000-1,499 1,500-1,999 2,000+
10. Is the academic performance of children a concern in the community (perform at least at grade level expectations? (Circle one)
Not a Concern Somewhat a Concern Very Concerning Issue
13. Do you feel nutrition, obesity, exercise, and healthy living/wellness is an issue in Ontario County? (Circle One) Yes No
14. How many people does your organization serve per year related to physical health? (Circle One)
0 1-499 500-999 1,000-1,499 1,500-1,999 2,000+
15. How many people does your organization serve with issues related to mental health? (Circle One)
0 1-499 500-999 1,000-1,499 1,500-1,999 2,000+
16. Do you feel the people you serve are concerned about any of the following? (Circle yes or no)
*If “Yes” please circle the number of people you serve regarding the specific issue per year
Relaxation/Stress Relief Yes No Domestic/Emotional Abuse Yes No
1-100 101-200 201-300 301-400 401+ 1-100 101-200 201-300 301-400 401+
Depression Yes No Anxiety /Stress Yes No
1-100 101-200 201-300 301-400 401+ 1-100 101-200 201-300 301-400 401+
Getting Healthy Food Yes No Exercise/ Recreation Yes No
1-100 101-200 201-300 301-400 401+ 1-100 101-200 201-300 301-400 401+
Substance Abuse Yes No Mental Health (i.e. depression, stress, anxiety) Yes No
1-100 101-200 201-300 301-400 401+ 1-100 101-200 201-300 301-400 401+
Attention Deficit / Hyper-activity Disorder (ADD/ADHD) Yes No
1-100 101-200 201-300 301-400 401+
17. Do you provide services for families in need of legal assistance related to the following? (Circle yes or no)
Child custody Yes No
Child support Yes No
Obtaining a lawyer for family court Yes No
Obtaining a lawyer for court in general Yes No
Child support Yes No
Divorce/Separation Conflicts Yes No
Custody Conflicts Yes No
18. Do you think people in your community/people you serve commonly feel unsafe or threatened in their homes or neighborhood? (Circle one) Yes No
19. Do you provide services to people who feel unsafe or threatened ? (Circle one) Yes No
*If “Yes” how many people do you serve per year?: 1-50 51-100 101-149 150-199 200-249 250-299 300-349 350-399 400-449 450-499 500+
20. Do you serve people affected by incarceration? (Circle One) Yes No
*If “yes”, in what ways have they been affected? (Circle all which apply)
Head of Household has had multiple incarcerations Have received services for incarceration
Family’s child care has changed Family income has changed
Housing/residency has changed Daily routine has changed
Family reports an increase in stress Family relationships have changed
Unemployment Difficulty paying bills/living expenses
21. Do you serve people who have concerns about transportation? (Circle one) Yes No
*If “Yes”, Circle all client concerns that apply:
Getting to and from work
Picking up/drop off child at school/daycare
Transportation to resource services (i.e. counseling services, health services)
Transport to and from food services (i.e. food banks, grocery stores)
22. Do you feel people in the community are aware of your organization and the services offered? (Circle One)
Yes No
22. Do you think people in the community are aware of the following emergency services available to them? (Circle yes or no)
American Red Cross Yes No 211 Yes No
Local Fire Departments Yes No Salvation Army Yes No
Poison Control Yes No Local food pantry Yes No
Catholic Charities Yes No FLACRA Yes No
Department of Social Services Yes No Other local counseling services Yes No
Area Hospitals and other Emergency Response Teams Yes No
Ontario County Mental Health Depart and Local Mental Health Agencies/Providers Yes No
23. Are you a one of the school districts in Ontario County? (Circle one) Yes No
**If “Yes” continue to the remainder of the survey
24. Does your school district have Universal Pre-Kindergarten (UPK)? (Circle One) Yes No
* If “Yes”, how many children are in UPK? (Fill in here) ______
25. How many children are in your school district? (Fill in here) _______
26. How many children in your school district receive Free or Reduced Lunch? (Fill in here) ______
27. Please comment on any other concerns you are aware of in the Ontario County community that your organization feels are important to the needs of the community residents.
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