Great Start Traverse Bay

2016 Betsie Valley Community Survey Volunteer Use Only/Name: Location: Day/Time:

Thank you for participating in the 2016 Betsie Valley Community Survey. Please take a few minutes to fill out this form and return it to the volunteer. We will use your input to meet community needs and potentially develop a new community center.

Background on You 1. Where do you live? □ Cleon Township □ Colfax Township □ Village of Copemish □ Grant Township □ Inland Township □ Joyfield Township □ Norman Township □ Springdale Township □ Village of Thompsonville □ Weldon Township □ Other: ____________ 2. Which town, village or city do you usually go to for groceries, appointments (e.g. medical appointments) and entertainment? (select all that apply) Town/Village/City Bear Lake Beulah/Benzonia Buckley Copemish Grawn/Interlochen Honor Manistee Mesick Thompsonville Traverse City Other (write in): Other (write in): Other (write in):

Groceries

Appointments

Entertainment

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How long have you lived at your current address? ___ years Do you own or rent your home? □ Own □ Rent □ Live with Someone Do you have a reliable car? □ Yes □ No □ Sometimes How many people currently live in your household? _____________ Ages of Adults: ______, ______, ______, ______, ______, ______, ______, ______ Ages of Children: ______, ______, ______, ______, ______, ______, ______, ______ 7. Do you take care of children at your home? (your own or anyone else’s)? □ Yes □ No 8. (Only if Children in Household) Where do your children attend school? __________________________ 9. (Only if Seniors in Household) Does anyone in your household ever visit The Gathering Place in Honor? □ Yes □ No 3. 4. 5. 6.

Community Needs 10. What are the biggest problems you see in your community? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________

11. What programs and services do you feel are missing in your community? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 12. If a Community Center opened on the campus of Betsie Valley Elementary School, what facilities, programs and services would you like to see? □ Child Care Center □ Cooking classes □ Workout facilities □ Adult sports leagues □ Shower facilities □ Laundry facilities □ Meeting rooms □ Computers and internet access □ Classes or training for adults □ Self-defense classes □ Medical appointments □ Dental appointments □ Vision appointments □ Mental health services □ Social events for seniors □ Low cost nutritious meals for seniors □ Activities/Services for teens (please explain below) 13. What else would you like to see at a Community Center at Betsie Valley Elementary School? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 14. Do you need childcare to be able to go to work or school? □ Yes □ No If yes: Do you need financial help to afford childcare? □ Yes □ No If yes: When do you need childcare? (select all that apply) □ Before 8 am □ 8 am to 3 pm □ 3 pm to 6 pm □ After 6 pm □ Weekends 15. Would you be interested in attending free playgroups or other activities for young kids in your community? □ Yes □ No 16. Would you be interested in attending social activities for parents? □ Yes □ No 17. Would you be interested in learning more about parenting (like classes)? □ Yes □ No 18. Are you familiar with these programs or groups? Head Start: □ Very familiar □ Somewhat familiar □ Not familiar Strengthening Families: □ Very familiar □ Somewhat familiar □ Not familiar Healthy Futures: □ Very familiar □ Somewhat familiar □ Not familiar 5 to One: □ Very familiar □ Somewhat familiar □ Not familiar More About You 19. Your Gender: □ Female □ Male 20. Your Age: □ Younger than 18 □ 18-24 □ 25-34 □ 35-44 □ 45-54 □ 55-64 □ 65-74 □ 75+ 21. Total Household Income: □ Less than $10,000 □ $10,000 - $24,999 □ $25,000 - $34,999 □ $35,000 - $49,999 □ $50,000 – $74,999 □ More than $75,000 22. Notes (if you have anything else to say from previous questions): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________