Individual Survey This survey is designed for individuals to provide feedback on their experiences and needs. personDemographics & BackgroundWhat is your age? What is your gender? What is your race/ethnicity? What is your ZIP code of residence? personEmployment Status & HistoryAre you currently employed? check_boxYescheck_box_outline_blankNo If not, when were you last employed? December JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 2025 1950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055SunMonTueWedThuFriSat 301234567891011121314151617181920212223242526272829303112345678910 What kind of work have you done in the past? What are the biggest barriers you face in finding or keeping employment? (Select all that apply) Lack of transportation Childcare needs Criminal record Health challenges Lack of skills or expertise Other (please specify) personEducation and SkillsWhat is the highest level of education you've completed? Do you have any certifications or licenses? If yes, please list them. What skills do you have that you believe are valuable in the workplace? personEntrepreneurship InterestAre you interested in starting your own business? (Yes/No/Maybe) check_boxYescheck_box_outline_blankNohelp_centerMaybe If yes, what type of business are you interested in starting? What kind of support would help you most with starting a business? Mentorship Business planning Access to funding Legal or licensing guidance Marketing support Other (please specify) personSupport ServicesWhat types of assistance would help you improve your employment or financial situation? (Select all that apply) Job training Resume/interview coaching Financial literacy Mental health support Housing assistance Childcare Transportation Do you currently access any support services or benefits (SNAP, Medicaid, LIHEAP, etc.)? check_boxYescheck_box_outline_blankNo personTechnology & CommunicationDo you have reliable internet access at home? check_boxYescheck_box_outline_blankNo Do you have a smartphone or tablet? check_boxYescheck_box_outline_blankNo What’s your preferred way to receive information about resources? (Text, Email, Mail, In-person, Other) saveSubmit Survey
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