Assessment Survey

Consistent with our mission, GEDDI is committed to gaining a comprehensive perspective into social factors that are a barrier to individuals attaining their fullest human potential in each of the communities we serve. We are conducting a Social Determinants Assessment to understand the broad needs of our communities. What you think about the Social Determinants and the needs of our community is important. We want to hear from you through this assessment. We listen in order to gain a better understanding of our communities’ needs and to make the best decision in offering strategies and providing feedback to partner organizations that are working to address racial barriers and Social Determinants.

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* 1. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 2. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

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* 3. What is your gender?

Female

Male

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* 4. What is the highest level of school you have completed or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

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* 5. What is your approximate average household income?

$0-$24,999

$25,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$124,999

$125,000-$149,999

$150,000-$174,999

$175,000-$199,999

$200,000 and up

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* 6. Which of the following categories best describes your employment status?

Employed, working full-time

Employed, working part-time

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

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* 7. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 8. How often do you exercise your right to vote?

Always

Usually

Sometimes

Rarely

Never

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* 9. How many relatives/friends do you see or hear from at least once a month?

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* 10. How many relatives/friends do you feel close to such that you could call on them for help?

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* 11. From the list below, what are the 10 issues with the greatest impact on the overall health of individuals in your community? Please select only ten.

Employment

Income

Expenses

Debt

Paying Bills

Financial Support

Housing

Transportation/ Mobility

Safety

Representation in government

Literacy

Communication/Language

Early Childhood Education

Vocational Training

Higher Education

Food Insecurity

Access to Healthy Food Options

Social Integration

Social Support Systems

Access to technology

Sense Of Belonging

Healthcare Insurance Coverage

Parks and Playgrounds

Policy decisions

Quality of Care

Racial Discrimination

Stress

Geography / ZIP code

Voting

Community Engagement

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* 12. Civil service and public service workers communicate with you and others adequately?

Always

Usually

Sometimes

Rarely

Never

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* 13. Within the past 12 months, how often have you put off paying bills because you couldn’t afford it?

Always

Usually

Sometimes

Rarely

Never

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* 14. Rank the items below based on their impact on the overall health of minorities in the community?

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* 15. In the past year, have you or anyone living with you experienced racial discrimination in any way?

Yes

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* 16. How would you rate your community’s education system?

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* 17. Do most people in your neighborhood have a smartphone, tablet or computer and have access to the internet?

Always

Usually

Sometimes

Rarely

Never