Community Supported Cafe Survey

We want to get to know you. Please fill out these questions. All responses are anonymous if you want them to be. If you provide us if with your name and contact information we will provide you with a $5 gift certificate towards the Local Sprouts Cafe.

1. Please fill out only the information you want to fill out on this form. If you do not want to provide your name or address we would love to get what town you live in.
Thanks

Please fill out only the information you want to fill out on this form. If you do not want to provide your name or address we would love to get what town you live in. Thanks Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:

2. How old are you?

How old are you? Under 18

18-24

25-31

32-38

39-45

46-52

53-59

60-70

70+

3. Which Portland Neighborhoods do you frequent?

	I live here	I work here	I visit friends here	I shop here	I pass through here	I go here once a week	I go here once a month	I go here a couple times a year	I hardly ever go here
East End	*Which Portland Neighborhoods do you frequent? East End I live here	East End I work here	East End I visit friends here	East End I shop here	East End I pass through here	East End I go here once a week	East End I go here once a month	East End I go here a couple times a year	East End I hardly ever go here
Downtown btwn Franklin & Forest	Downtown btwn Franklin & Forest I live here	Downtown btwn Franklin & Forest I work here	Downtown btwn Franklin & Forest I visit friends here	Downtown btwn Franklin & Forest I shop here	Downtown btwn Franklin & Forest I pass through here	Downtown btwn Franklin & Forest I go here once a week	Downtown btwn Franklin & Forest I go here once a month	Downtown btwn Franklin & Forest I go here a couple times a year	Downtown btwn Franklin & Forest I hardly ever go here
Arts District btwn Forest & State	Arts District btwn Forest & State I live here	Arts District btwn Forest & State I work here	Arts District btwn Forest & State I visit friends here	Arts District btwn Forest & State I shop here	Arts District btwn Forest & State I pass through here	Arts District btwn Forest & State I go here once a week	Arts District btwn Forest & State I go here once a month	Arts District btwn Forest & State I go here a couple times a year	Arts District btwn Forest & State I hardly ever go here
Bayside	Bayside I live here	Bayside I work here	Bayside I visit friends here	Bayside I shop here	Bayside I pass through here	Bayside I go here once a week	Bayside I go here once a month	Bayside I go here a couple times a year	Bayside I hardly ever go here
East Bayside	East Bayside I live here	East Bayside I work here	East Bayside I visit friends here	East Bayside I shop here	East Bayside I pass through here	East Bayside I go here once a week	East Bayside I go here once a month	East Bayside I go here a couple times a year	East Bayside I hardly ever go here
Old Port	Old Port I live here	Old Port I work here	Old Port I visit friends here	Old Port I shop here	Old Port I pass through here	Old Port I go here once a week	Old Port I go here once a month	Old Port I go here a couple times a year	Old Port I hardly ever go here
West End	West End I live here	West End I work here	West End I visit friends here	West End I shop here	West End I pass through here	West End I go here once a week	West End I go here once a month	West End I go here a couple times a year	West End I hardly ever go here
Parkside	Parkside I live here	Parkside I work here	Parkside I visit friends here	Parkside I shop here	Parkside I pass through here	Parkside I go here once a week	Parkside I go here once a month	Parkside I go here a couple times a year	Parkside I hardly ever go here
Rosemont	Rosemont I live here	Rosemont I work here	Rosemont I visit friends here	Rosemont I shop here	Rosemont I pass through here	Rosemont I go here once a week	Rosemont I go here once a month	Rosemont I go here a couple times a year	Rosemont I hardly ever go here
Deering	Deering I live here	Deering I work here	Deering I visit friends here	Deering I shop here	Deering I pass through here	Deering I go here once a week	Deering I go here once a month	Deering I go here a couple times a year	Deering I hardly ever go here
North Deering	North Deering I live here	North Deering I work here	North Deering I visit friends here	North Deering I shop here	North Deering I pass through here	North Deering I go here once a week	North Deering I go here once a month	North Deering I go here a couple times a year	North Deering I hardly ever go here
Woodfords Corner	Woodfords Corner I live here	Woodfords Corner I work here	Woodfords Corner I visit friends here	Woodfords Corner I shop here	Woodfords Corner I pass through here	Woodfords Corner I go here once a week	Woodfords Corner I go here once a month	Woodfords Corner I go here a couple times a year	Woodfords Corner I hardly ever go here
Back Cove	Back Cove I live here	Back Cove I work here	Back Cove I visit friends here	Back Cove I shop here	Back Cove I pass through here	Back Cove I go here once a week	Back Cove I go here once a month	Back Cove I go here a couple times a year	Back Cove I hardly ever go here

Other (please specify)

Community Supported Cafe

1. About You