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52 <br /> III. Let's talk about services... <br /> 13) Who do you go to if you have a problem or need help?(check all that apply) <br /> ❑ Neighbor ❑ Church ❑ Family member <br /> ❑ Friend 0 Public Agency 0 Other <br /> 14) Have you ever sought services from an agency? ❑ Yes ❑ No <br /> If yes, what agency/agencies? (check all that apply) <br /> ❑ Social Services ❑ Health Department ❑ Women's Shelter <br /> ❑ Inter-Faith Council (IFC) ❑ Mental Health ❑ Day Care Agency <br /> 0 Public Housing ❑ OCIM 0 JOCCA <br /> ❑ Public School ❑ Community House/IFC Shelter <br /> ❑ Other <br /> 15) Does anyone in your household receive or need help with any of the following services? <br /> Receives Currently Needs Help With <br /> ❑ Aid to Families with Dependent ❑ 0 <br /> Children(AFDC) <br /> ❑ Food Stamps ❑ 0 <br /> ❑ Veteran's Assistance (VA) ❑ ❑ <br /> ❑ Educational Assistance ❑ 0 <br /> ❑ Child Support ❑ ❑ <br /> ❑ Supplemental Security Income ❑ ❑ <br /> (SSI/Disability) <br /> ❑ Medicaid ❑ 0 <br /> ❑ Social Security 0 0 <br /> ❑ WIC (Nutrition Program: Women, 0 0 <br /> Infants and Children) <br /> ❑ Housing (Rental Subsidy) 0 0 <br /> 16) Does anyone in your household need help now with any of the following? <br /> ❑ Paying for Child Care ❑ Paying for Adult Day Care <br /> ❑ Finding Child Care 0 Finding Adult Day Care <br /> ❑ Transportation 0 Medical/Health Care <br /> ❑ Prenatal Care ❑ Mental Health Care <br /> 0 Child Immunizations/shots 0 How to Discipline Your Children <br /> ❑ Dental Dare ❑ Violence <br /> ❑ Vision 0 Money Management <br /> ❑ Getting a high school diploma 0 Nutrition Education <br /> 0 Learning to read ❑ Drug or Alcohol Problems <br /> ❑ Food ❑ Disabilities <br /> 0 Parenting Education <br /> ❑ Other <br />