2025 Annual Survey! Please enable JavaScript in your browser to complete this form. – Step 1 of 2 Tribal Member ID/Number * All survey answers will remain completely confidential and won’t be linked to Tribal ID/Numbers. Start General Information Do you reside in one of the two surrounding counties (Thurston or Grays Harbor) of the Reservation? * Yes No If yes, Select one of the following: * Grays Harbor Thurston Where do you reside? * Chehalis Reservation Oakville Rochester Centralia/Chehalis Tumwater/Olympia/Lacey Out of State Other: If other, please specify: * How old are you? * 18-24 25-34 35-44 45-54 55-64 65-74 75+ What is the highest level of education you have attained? * Some high school High School Graduate GED/Equivalent Some college Professional Certification Vocational/Trade School AA Degree Bachelor’s Degree Graduate/Professional Degree Are you currently employed? * Yes, Full-time Yes, Part-time Yes, Self-employed Yes, business owner. No, unemployed. No, furloughed. No, Disabled/unable to work. No, don’t need to work. Seasonally employed. Retired If not, what are the barriers preventing your employment? * Disability Addiction Laid off, expecting to return to work. Lack of childcare Personal/family responsibilities Lack of necessary skills qualifications Lack of transportation Lack of available jobs Other: If other, please specify: * What is your household’s annual income not including GWE? * Less than $25,000 $25,000 to $49,999 $50,000 to $99,999 $100,000 to $149,999 $150,000 to $199,999 $200,000 to $299,999 $300,000 to $399,999 $400,000 or more Social Services Do you have child car seats that are appropriate for the age/size of your child? * Yes No This question doesn’t apply to me Do you need assistance with purchasing age/size appropriate car seats? * Yes No This question doesn’t apply to me Within the last 3 years have you applied for food stamp (SNAP) benefits? * Yes, I am currently receiving SNAP benefits I applied but was denied No, I haven’t applied I applied but was denied (SNAP) If denied, were you told you do not qualify (SNAP)? * Yes No If denied, did you not qualify due to (select one) * Family size Over income GWE benefits counted against you Other: If other, please specify: * Within the last 3 years have you applied for TANF (Temporary Assistance for Needy Families) in the State of Washington. (SELECT ONE) * Yes, I currently receive TANF benefits Yes, I currently receive child-only TANF benefits I applied through the state but was denied I applied through a tribe but was denied No, I haven’t applied Yes, I currently receive TANF benefits If yes: Did you apply through the state or a tribe? * State Tribe Yes, I currently receive child-only TANF benefits If yes: Did you apply through the state or a tribe? * State Tribe I applied through the state but was denied If denied, were you told you do not qualify (thru state)? * Yes No If denied, did you not qualify due to (select one) * Family Size Over income GWE benefits counted against you Other: If other, please specify: * I applied through a tribe but was denied If denied, were you told you do not qualify (thru tribe)? * Yes No If denied, did you not qualify due to (select one) * Family Size Over income GWE benefits counted against you Other: If other, please specify: * Housing What is your current living situation? * Rent Homeowner with a mortgage Homeowner without a mortgage Living with friends/family Hotel/Motel Homeless Other: If other, please specify: * Which best describes the home you live in? * One family house detached from any other houses. Duplex or townhome Apartment of condominium Mobile/Manufactured home RV Other: If other, please specify: * In the past 12 months have you ever been without a home or homeless? * Yes No What types of housing would you like to see more of on the Chehalis reservation? (check all that apply) * Affordable rentals First-time buyer homes Senior housing Family-sized housing (4 bedrooms or more) Transitional housing for people in recovery Accessible/disability-friendly housing Elder’s assisted living Other: If other, please specify: * If new housing were built at Briarwood, would you be interested in a home there? * Yes No, I already have a home No, I’m not interested in relocating If yes: what is the type of homeownership you want: * Buy a pre-built home Lease land and build my own home (Homesite Lease Program) Rent a home Other: If other, please specify: * What type of housing would you want to live in at Briarwood? * Single-family home Townhouse Duplex, triplex or fourplex Apartment (building with over 5 units) Accessory dwelling unit (small unit either attached or adjacent to main house) Other: If other, please specify: * How many bedrooms would you need? * 1 bedroom 2 bedrooms 3 bedrooms 4 bedrooms or more Other: If other, please specify: * The Chehalis Tribe is currently working on developing the former Briarwood property into housing, parks and other community development. The name for this property needs to be identified. Please select ONE below for a new name for Briarwood. Words from the Upper Chehalis Dictionary, by M. Dale Kinkade. * ‘Get back to ones homeland’ (pg. 236) Pronounced: THLach ahy tmsh/ thlatchaytumsh * ‘Slough west of Rochester’ (pg.330 map on 331) Pronounced: kway lest ah/ Kwaylesta/ Qwaylesta * ‘People of a prairie’ (pg. 273) Pronounced: sm awh qwam umsh/ smawqwamumsh ‘Place where one stays, living place’ (pg. 271) Pronounced: wayn tin ‘River side of a prairie’ (pg. 279) Pronounced: t AH lay chay qua /Tahlaychayqwa ‘People of a village’ (pg. 313) ‘neighbor, company, companion’ Pronounced: qwah THLshum/ qualthshum Other *Verified with Marla Conwell on pronunciation. If other, please specify: * Chehalis Tribal Loan Fund Would you participate in any of the following housing support programs offered by the Chehalis Tribal Loan Fund (check all that apply) * Down payment assistance Homebuyer education workshops Home repair loans Mortgage Loans None of these How interested would you be in a CTLF program that helps members buy reliable vehicles (through education, fair lending, and coaching)? * Not at all interested Slightly interested Moderately interested Interested Very interested How likely would you or someone in your household be to use a Tribal business incubator (offering office space, coaching, and support for small businesses)? * Very unlikely Unlikely Neutral/Unsure Likely Very likely How likely would you be to use a credit union hub located inside the CTLF office (in Oakville) for banking services (deposits, withdrawals, account management)? * Very unlikely Unlikely Neutral/Unsure Likely Very likely Chehalis Tribal Wellness Center Do you receive health care at the Chehalis Tribal Wellness Center? * Yes No If yes: How easy was it to schedule your appointment? * Very difficult Difficult Neutral Easy Very easy How long was your wait time between booking your appointment and the actual visit? * Less than 3 days 4 days to 1 week 1 week to 2 weeks 2+ weeks Have you ever been refused service or turned away at the Chehalis Tribal Wellness Center? * Yes No If yes, why? * In the past 12 months, what has been your biggest challenge in receiving care at CTWC? (Select all that apply) * Wait times for appointments Hours of operation Transportation Cost/Insurance Coverage Communication/Scheduling Difficulties No Challenges Other: If other, please specify: * Overall, how well are the CTWC’s services meeting the health needs of you and your family? * Not well at all Not very well Neutral Somewhat well Very well What other services would you like offered at the Wellness Center? (Select all that apply) * Chiropractor Massage Therapist Natural/Holistic/Traditional Healing Nutrition and wellness program Acupuncture Physical Therapy Extended Urgent Care hours Women’s Health services Specialty clinics (e.g., cardiology, dermatology) Additional dental services Additional pharmacy support (e.g., medication delivery, refills) Other: If other, please specify: * Behavioral Health Do you or your immediate family currently receive services from Tsapowum Behavioral Health? * Yes No If yes, How satisfied are you with the Behavioral Health services you or your family have received? * Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied Are our current Behavioral Health services (mental health counseling, substance use treatment, domestic violence advocacy) meeting the needs of you and your family? * Yes No If no, why? * Would you participate in any of the following culturally grounded healing opportunities? (Select all that apply) * Wellbriety Sweat lodge Traditional Practices Wood working therapy Elder’s/Youth connection activities None of the above Other: If other, please specify: * What barriers, if any, make it difficult for you or others to access Behavioral Health services (Select all that apply) * Location Transportation Scheduling Privacy awareness of services other: none If other, please specify: * Do you feel respected, listened to, and supported when working with Behavioral Health staff? * Yes No Do you feel your privacy and confidentiality are protected when using Behavioral Health services? * Always Most of the time Sometimes Rarely Never Heritage & Culture What kind of classes would you like to see in H&C? (select all that apply) * Quilts Large cedar projects smaller cedar projects Carving Carpentry wool weaving sweetgrass cattail sewing beading painting Regalia making language traditional medicines story telling/ oral history other: If other, please specify: * Do you feel like you receive proper notification of classes happening for the quarter? * Yes No If no, how should we send notifications? * Social media Tribal member email list mailing Would you utilize the wood shop if there were proper tools in it? * Yes No What type of support would make it easier for you to attend? (Select all that apply) * Childcare Weekend/evening classes Transportation Better communication Youth-friendly classes Elder-friendly classes Other: If other, please specify: * Do you believe youth have enough opportunities to learn about and participate in Chehalis heritage and culture? * Yes No On a scale of 1–5, how well do you feel the current heritage and culture programs meet the needs of the community? * not well at all somewhat well neutral well very well Would you like to learn more about traditional foods, songs, dances, ceremonies? * Yes No Elders Questions (55+ ONLY) Do you have access to enough healthy food each day? * Yes No Not all the time Do you have access to proper hygiene necessities? (example: Deodorant, paper towels, tissues, laundry detergent, soap, cleaning supplies) * Yes No Not all the time What is your main heat source for the colder months? * Wood stove Propane stove Electric Other: None If other, please specify: * What is your main source for cooling for the hotter months? * A/C Fan Other: None If other, please specify: * Would you be interested in exercise, nutrition, or wellness programs specifically tailored for Elders? * Yes No What kind of activities or events would you like to see offered at the elder’s center? (Select all that apply) * Movie nights Crafts Game nights Cultural Activities Light physical activities Baking classes Van to Farmer’s market shopping Van to Grocery shopping Other: If other, please specify: * Do you have enough income to meet your basic needs? (food, housing, bills, transportation) * No Yes Sometimes =============++++++++++++++++++++++++++++++++++++++++++++++============= Additional comments, questions, suggestions can be entered below… Additional Comments: Please mark X below to prevent SPAM! * Clear Signature This form does not collect esignatures! NOTE: After clicking on the Submit Now button, please wait for the Thank you message to load for confirmation of successful submission!!! I'm Done with this Form – Submit Now!
