Home Sharing (providers)

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1. What is your age?

What is your age?

2. What is your gender?

What is your gender?   Male Female

3. Have you ever shared your home with someone in exchange for rent or services (housekeeping, shopping, cooking, transportation, etc)?

Have you ever shared your home with someone in exchange for rent or services (housekeeping, shopping, cooking, transportation, etc)?   Yes No

4. If yes to question #3, please rate your experience in the following areas as they related to sharing your home:

	Good	Fair	Poor	N/A
I had enough privacy	*If yes to question #3, please rate your experience in the following areas as they related to sharing your home: I had enough privacy Good	I had enough privacy Fair	I had enough privacy Poor	I had enough privacy N/A
I enjoyed the companionship of my roommate	I enjoyed the companionship of my roommate Good	I enjoyed the companionship of my roommate Fair	I enjoyed the companionship of my roommate Poor	I enjoyed the companionship of my roommate N/A
Rent was paid on time	Rent was paid on time Good	Rent was paid on time Fair	Rent was paid on time Poor	Rent was paid on time N/A
The services I requested were provided	The services I requested were provided Good	The services I requested were provided Fair	The services I requested were provided Poor	The services I requested were provided N/A

5. Would you be interested in sharing your home?

Would you be interested in sharing your home?   Yes No (Skip to question #8)

6. If yes to question #5, would you want to receive rent or services from your roommate?

If yes to question #5, would you want to receive rent or services from your roommate?   Rent Services Both

7. If yes to question #5, what requirements would you have of your roommate?

If yes to question #5, what requirements would you have of your roommate?   No smoking No pets

No alcohol Other __________________________________

8. What might attract you to having a roommate?

What might attract you to having a roommate?   Companionship Help around the house Extra income

Security Nothing Other ____________________________

9. What concerns do you have about sharing your home with others?

What concerns do you have about sharing your home with others?   I don't want to live with others I might not find anyone I like Security of my belongings

Loss of government benefits Lack of privacy Other _________________________________

10. Where do you go for information on senior topics?

Where do you go for information on senior topics?

11. We're trying to find people who have an extra room in their living situation. How effective do you think the following sources would be at reaching those individuals?

	Above Average	Average	Poor	N/A
Newspaper Advertisements (Classifieds)	*We're trying to find people who have an extra room in their living situation. How effective do you think the following sources would be at reaching those individuals? Newspaper Advertisements (Classifieds) Above Average	Newspaper Advertisements (Classifieds) Average	Newspaper Advertisements (Classifieds) Poor	Newspaper Advertisements (Classifieds) N/A
Mailings	Mailings Above Average	Mailings Average	Mailings Poor	Mailings N/A
Presentations at community organizations and public spaces	Presentations at community organizations and public spaces Above Average	Presentations at community organizations and public spaces Average	Presentations at community organizations and public spaces Poor	Presentations at community organizations and public spaces N/A
Internet	Internet Above Average	Internet Average	Internet Poor	Internet N/A

12. Please list some venues i.e. churches, senior centers, that you think would provide an opportunity for reaching seniors with housing to share. Thank you for your suggestions!

Please list some venues i.e. churches, senior centers, that you think would provide an opportunity for reaching seniors with housing to share. Thank you for your suggestions!

13. Do you know of anyone who has been in a roommate situation?

Do you know of anyone who has been in a roommate situation?   Yes, they had a good experience Yes, they had a poor experience

Yes, but I'm not sure how they felt about their experience No