Community Development Disabled Tenant Survey 2012
Basic Information
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1
. Zip Code of residence
Zip Code of residence
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2
. What is your current living situation?
What is your current living situation?
Living temporarily with others
Living alone
Living with immediate family
Living with extended family
Living with roommates
Living in a shared situation with another family
Living in a nursing facility or institution
Homeless, living in a shelter or motel - looking for a place to live
Homeless, living in a shelter or motel - not looking for a place to live
Homeless, not living in a shelter or motel
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3
. Indicate your family size
Indicate your family size
1
2
3
4+
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4
. Indicate your age range
Indicate your age range
10 or younger
11 - 17
18 - 34
35 - 50
51 - 65
66 - 79
80 or older
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5
. Indicate your income range
Indicate your income range
Less than $10,000
$10,000 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 or more
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