WHEDco, a community development organization in the South Bronx, and the Partnership for a Healthier Bronx at Bronx Health REACH, a community-based coalition committed to improving the health of Bronx residents, are surveying Melrose community members on their needs and interests. We will use this information to design programs to meet those needs and advocate around the community’s pressing concerns. Your responses will be confidential.

* I live in zip code

* I work/go to school in zip code

* Please tell us how you feel about your neighborhood. Check one per question.

  Strongly Agree Agree Neutral Disagree Strongly Disagree
My neighborhood is safe
My neighborhood has affordable housing
My neighborhood is close enough to buses
My neighborhood is close enough to trains/subways
My neighborhood is clean and well-maintained
I can get healthy foods in my neighborhood
I have access to high-quality health services in my neighborhood
I know about community events and resources in my neighborhood
I have access to places to exercise in my neighborhood
I like my neighborhood

* Please tell us about you/ your family:

  Full time Part time Not Working/in School
Are you working?
Are you in school?

* If you are the primary caretaker of a child/children, please answer the following questions.

If your child/children are younger than 5 years old:

  Yes No
(i) Do you have childcare for them?
If Yes to (i), Is the childcare near where you live/work?
(ii) Are you satisfied with the quality of childcare?
(iii) Is the childcare affordable?

* If your child/children are in elementary or middle school:

  Yes No
(i) Are they in an after school program?
(ii) If they are not in an after school program, is it because there was no space in the program?
(iii) Are you satisfied with the quality of After School?

* If your child/children are in school (K-12) are you satisfied with the quality?

* In general, how would you rate your own health?

* Do you have a main doctor?

* If yes, I go

* Are you or anyone in your family dealing with any of these health issues? Please check all that apply.

* Have you seen a specialist within the last 12 months for any of these health issues?

* Typically, how many pieces of fruits or servings of vegetables do you eat a day?

* During the past 30 days, did you participate in any physical activity or exercise?

* Please tell us a few things about smoking:

  Yes No
I live in a smoke-free building
Does anyone smoke tobacco products in your apartment?
Would you be interested in living in a smoke-free building?

* What kind of music do you listen to? Please check all that apply.

* Do you know of any Bronx-based musicians?

* What is the name of the musician or his/her band?

* What is the best way to contact this musician for an event?

* What types of business/organizations would you most like to see in your neighborhood? Please select your top 3 only

* What things would you like some help with? Please check all that apply.

* Finally, some basic questions about you and your household.

(i) What is your:

* (ii) How many people in your household are?

* (iii) Please select which of the following best describes your annual household income.

* (iv) Please check all of your major sources of income:

* We would like to be able to follow-up with you. If you are willing, please provide your contact information below.