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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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