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1. Lack of Affordable Housing in this community is a problem because:

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2. Unemployment is a problem in this community  because:

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3. High heating and utility costs are a problem in this community because:

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4. Transportation is a problem because:

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5. Please choose 3 of the following areas that are most important to you right now.

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6. In your view of the following, which are the most important to having a good community? (Choose 3)

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7. Which of the following are missing from your neighborhood? (Check all that apply)

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8. What is your usual work or school schedule:

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9. Do you use childcare outside of your home while you work or attend school?

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10. If you use childcare, do you utilize family members or a licensed childcare center?

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11. If you do not use licensed childcare, please tell us why. Mark all that apply:

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12. Do you feel there is an issue with substance abuse in your neighborhood?

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13. Culture

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14. Sex:

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15. Age Group:

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16. Marital Status

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17. Schooling, last grade completed:

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18. Applying for:

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19. Source of Income (Note: If you have more than one source of income, check all that apply):

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20. Which do you have at home (check all that apply):

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21. Do you have access to the internet at home?

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22. Are you a homeowner or renter?

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23. How many times have you moved in the past year?

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