Manchester Health Needs Assessment: Conducted by the Board of Health

1. About You and Your Household

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Please complete the following survey so that we can use the information collected to assess the needs of Manchester-by-the-sea and implement programs to meet your needs.

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Manchester Health Needs Assessment: Conducted by the Board of Health

1. About You and Your Household

1. Are you a permanent resident of Manchester-by-the-sea (i.e. you reside in your Manchester dwelling for at least 8 months out of the year)?

2. How long have you lived in Manchester-by-the-sea?

3. Please indicate your age range.

4. Please indicate your sex.

5. How many children under the age of 18 live in your home?

6. What are the age ranges of the children that live in your home? Please check all that apply.