How Are YOU doing, CK Families?

Please share with us how COVID has affected you as a parent, and please encourage your child(ren) to also complete the survey from their viewpoint. This will give us a clearer understanding of everyone's needs, plus it may also open the door to some supportive conversations within your family. Thank you in advance for your time and feedback!

All fields marked with an asterisk (*) are required

We are seeking feedback from parents and youth about their experience of COVID. Please choose the best option below for you:

* required

I’m a Parent or primary caregiver to children

I’m a youth (24 years or younger) without children

What has helped you the most to cope during the COVID-19 pandemic? (please include services or help from friends/family, etc.)

* required

Over the next 12 Months, what are your THREE biggest concerns?

* required

What services, either that already exist or new services that you wish were available, might support you with your biggest concerns (select all that apply)

* required

Housing / income supports

Employment services

Mental health supports

Addictions / substance use services

Physical health supports (i.e. access to a doctor)

Reproductive or sexual health services

Recreation

Social connections

Transportation

Access to internet / technology

Educational supports

Other / More services and supports

Is there anything else you would like the leaders in Chatham-Kent to know about your experience of COVID-19, or what you would like to see happen to support your family in the community, now and in the future?

Where do you live? (Check all that apply if you have multiple residences)

Central Chatham

East Chatham

North Chatham

Tilbury or Wheatley

Blenheim

Ridgetown

Thamesville

Dresden/Bothwell

Pain Court

East Wallaceburg

West Wallaceburg

Prefer not to answer

Other

We Ask Because We Care

We are collecting the following information to find out more about you, our unique Chatham-Kent families, so we can better support you with our services and programs.

These questions are voluntary and you can choose ‘prefer not to answer’ to any or all questions.

All data is combined in such a way that we will not be able to identify any one person or family with this information.

Which of the following best describes your racial or ethnic group?

Asian - East (e.g. Chinese, Japanese, Korean)

Asian - South (e.g. Indian, Pakistani, Sri Lankan)

Asian - South East (e.g. Malaysian, Filipino, Vietnamese)

Black - African (e.g. Ghanaian, Kenyan, Somali)

Black - Caribbean (e.g. Barbadian, Jamaican)

Black - North American (e.g. Canadian, American)

First Nations (Please specify below)

Indian - Caribbean (e.g. Guyanese with origins in India)

Inuit

Latin American (e.g. Argentinean, Chilean, Salvadoran)

Métis

Middle Eastern (e.g. Egyptian, Iranian, Lebanese)

White - European (e.g. English, Italian, Portuguese, Russian)

White - North American (e.g. Canadian, American)

Mixed heritage (e.g. Black - African & White - North)

Other(s): (Please specify below)

Do not know

Prefer not to answer

Do you have any of the following? Check ALL that apply

Chronic Illness

Developmental Disability

Drug or Alcohol Dependence

Learning Disability

Mental Illness

Physical Disability

Sensory Disability (i.e. hearing or vision loss)

Do not know

Other (Please Specify below)

Prefer not to answer

What is your gender?

Female

Intersex

Male

Trans - Female to Male

Trans - Male to Female

Two-Spirit (a term used by Aboriginal people)

Other (Please specify below)

Do not know

Prefer not to answer

10.

What is your sexual orientation?

Bisexual

Gay

Heterosexual (straight)

Lesbian

Queer (a term used by people who do not follow common sexual orientations)

Two-Spirit (a term used by Aboriginal people)

Other (Please specify below)

Do not know

Prefer not to answer

11.

What was your total family income before taxes last year?

$0 - $14,999

$15,000 – $19,999

$20,000 – $24,999

$25,000 – $29,999

$30,000 – $34,999

$35,000 – $39,999

$40,000 – $59,999

$60,000 or more

Do not know

Prefer not to answer

... and that's it!

Please click the "Submit" button to end the survey.