RESIDENT SURVEY

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* 1. Today's Date

Date

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* 2. In what zip code is your home/property located?

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* 3. Address (Optional)

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* 4. Which flood event were you affected by?

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* 5. Was your home damaged during the floods? If yes, how much did you spend to repair the damage to your property?

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* 6. What kind of damage did you have to your home/property:

  Roof (holes, depressed sections, tarps over sections) Siding (holes, missing siding, broken/boarded up windows) Structure (missing walls, foundation displayed) Water damage to floor, walls Home destroyed/uninhabitable
Choose all that apply.

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* 7. In your neighborhood after the floods, did you see the following along the curb for trash pickup:

  Vegetation (trees, branches, etc.) Flooring (carpet, etc.) Furniture (mattresses, couches, etc.) Excessive Trash
Choose all that apply.

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* 8. Best describe the degree of flooding on the roads in your area/neighborhood during or after the flood.

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* 9. Have you filed a claim with your insurance company/or FEMA regarding damage caused by flooding?

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* 10. Additional comments:

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