Cooling Assistance Needs Survey – Alabama Council on Human Relations, Inc

What city do you live in?

Monthly Income level: *

Race: *

Total number of people living in your household: *

Total number of children (18 or younger) living in your household: *

1. Employment/good paying jobs: *

2. Job Training *

3. Transportation (to work, child care, grocery store, etc.) *

4. Wraparound child care and (before/after school and during summer) and full time day care *

5. Housing (safe and comfortable) *

6. Healthcare *

7. Internet Access *

8. Crime *

9. Community/school violence *

10. Physical, emotional, and sexual abuse *

11. Drug/Alcohol addiction (opioids, street drugs, etc.) *

12. Discrimination *

Please describe largest problem in your community *