:: United Way of Central West Virginia ::

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Community Survey

The United Way of Central WV's mission is to improve the quality of life in our community. We need your help to identify the most pressing needs in our community. Your responses will enable us to better target our resources to those areas of greatest need. You do not need to rank your responses. All responses will be anonymous and confidential.

Are you a United Way Donor? YES | NO

Please Enter Your Zip Code:

Are you a non-profit agency executive or on the board of a non-profit? YES | NO

What are the five (5) most important HEALTH concerns in your community? (check 5 boxes)
Access to health care
Health insurance (includes drug coverage)
Dental care
Adolescent pregnancy
Food safety
Immunization levels upon entrance to school
Lead poisoning
Obesity and nutrition
Physical activity
Sexually transmitted disease
Tobacco use
Prenatal care
Prescription drug abuse
Availability of long-term care
Mental health/Mental Retardation services
Mental health, Depression and Suicide
Alcohol and substance abuse treatment
Asthma
Cancer (type: )
Cardiovascular disease
Diabetes
Unintentional injury
Chronic pain
Other, please list below

What are the five (5) most important EDUCATION concerns in your community? (check five boxes)
Literacy
Post secondary education accessibility
High school dropout rates
College attendance
Job training
Educational attainment
English proficiency
Library use
Respect for cultural differences
County and State ACT/SAT test scores
School safety
Athletic facilities/physical education
Parent participation
Early childhood education and school readiness
GED availability
Adult education
School bullying
English as a second language
School facilities
School discipline policies
Quality of educational system
Others, please list below

What are the five (5) most important PUBLIC SAFETY concerns in your community? (check 5 boxes)
Crime rate
Juvenile crime rate/arrests
Child abuse and neglect
Response to disaster preparedness
Sexual abuse
# of Police officers per capita
Police response by jurisdiction
ATV accidents
Vandalism
Illegal production and use of drugs (meth, marijuana)
Driving under the influence (DUI)
Juvenile drug arrests
Adult drug arrests
Motor vehicle accidents
Concern about crime
Hunting accidents
Neighborhood safety
Others, please list below

What are the five (5) most important SOCIAL ENVIRONMENT concerns in your community? (check 5 boxes)
Availability of child and youth services
Availability of elderly and disabled services
Opportunity for home ownership
Affordability of rental housing
Homelessness
Racism
Hate crimes
Voter turnout
Gang activity
Family/domestic violence
People served by food banks
Volunteerism
Charitable giving
Discrimination (type: )
Preservation of historic sites
Others, please list below

What are the five (5) most important ECONOMIC DEVELOPMENT concerns in your community? (check 5 boxes)
Median household income
Business start-up opportunity
Financial/credit counseling
Unemployment
Skilled workforce
Jobs/employment opportunity
Poverty levels
Temp. economic assistance for needy families
Child care availability/affordability
Business start-up opportunities/job growth
Business closures
Retail sales
Tourism
Arts, culture, and recreational opportunities
Utility costs
Tax burden
Zoning ordinances
Others, please list below

What are the five (5) most important NATURAL ENVIRONMENT concerns in your community? (check 5 boxes)
Urban green space
Habitat preservation
Natural disasters
Wetlands
Adequacy of park lands
Miles of recreational trails
Accessibility of park use
Health of waterways
Drinking water
Air quality
Ecological restoration
Highway conditions
Traffic conditions
Alternative transportation
Waste water treatment
Recycling-waste reduction
Master planning
Neighborhood revitalization
Others, please list below

The United Way of Central West Virginia is also a member of the Kanawha Valley Coalition for Community Health Improvement. Your responses to the following questions will broaden the Coalition's understanding of the health and health needs of the community, starting with our United Way family, both the populations we serve and our donors. [All responses will be anonymous.]

What is your gender? MALE | FEMALE

In what year were you born?

What is your current marital status? Married | Separated | Divorced | Widow(er)

How many people live in your household? Adults (Over 18): Children:

What is your current employment status? Employed Full-time | Employed Part-time | Student |
Homemaker | Retired | Unemployed

Do you consider yourself: White | African American | Biracial | American Indian | Asian |
Alaskan Native | Other

What is the highest level of education that you have completed? 8th grade or less | Some high school |
High school graduate/GED | Technical school/skilled trade | Some College | Bachelor's degree |
Graduate or professional degree

What is your household income? Less than $10,000 | $10,000 - $20,000 | $20,000 - $30,000 |
$30,000 - $50,000 | $50,000 - $80,000 | More than $80,000

What is your zip code?

How many years have you lived in this zip code?

In general, how would you rate your health? (Rate from 1 (very poor) to 7 (excellent))

Do you use tobacco products? Yes | No

Do you have a regular source of medical care? Yes | No

What is your height/weight? Height (ex. 6'0"): Weight:

Has a doctor or other health care professional ever told you that you had the following:

a. High cholesterol Yes | No

b. High blood pressure Yes | No

c. Asthma Yes | No

d. Diabetes Yes | No

e. Depression Yes | No

f. Heart disease Yes | No

g. Cancer Yes | No