Project Self Sufficiency
Interest Survey - English


Name:_______________________________________
Address:_____________________________________
City:______________________Zip:_______________
Phone:______________________________________

I would like to see the group work on the following issues (please rank 1 - 7):

____Improving services at the welfare office (worker attitudes, reducing paperwork, verification, etc.)

____Increasing access to affordable, quality child care

____Improving access to quality education and job training programs for women (improving self-sufficiency program, JTPA, etc.)

____Improving the child support collection process

____Increasing the availability of affordable housing for single people as well as families

____Sexual harassment and personal safety

____Educating the public about welfare and other women's issues

____Other issue_________________________________________

I want to:

____be on the core committee (and attend the biweekly meetings)

____be on an issue action committee

____help recruit other women

____help write newsletters and action alerts

____help with fundraising

What kind of activities do you (would you) enjoy?

____talking with other people ____public speaking

____reading ____working with computers

____writing ____planning action on issues