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* 1. What military installation is your privatized housing associated with?

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* 2. Have you had to contact your housing company for work orders or other issue resolution? Please list all that apply.

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* 3. What racial/ethnic groups do you belong to?

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* 4. How do you describe your gender identity?

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* 5. How do you like to describe your sexual identity or sexual orientation?

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* 6. Do you identify as a person with a disability or are you a person with accessibility needs? Please describe all that applies.

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* 7. On a scale from 1 to 5, where is 1 is Strongly Disagree and 5 is Strongly Agree, how would you rate the following statements?

  Strongly Disagree Disagree Neutral Agree Strongly Agree
My housing company values diversity.
I feel a sense of belonging at, and safety in, my housing community.
I feel respected by my housing employees.
People from all backgrounds and with a range of identities have equitable opportunities and response to their housing needs in my housing community.
I feel comfortable talking about issues of racism with my housing employees.
I know where to find resources if I have been discriminated against by my housing company.

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* 8. Have you experienced any unwelcome comment(s) or conduct by your housing company that you felt was offensive, embarrassing, or hurtful (e.g., inappropriate jokes, slurs, rumors, hurtful gossip, isolating behaviors)? Please describe.

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* 9. Have you experienced any discrimination (i.e., unfair, negative, or adverse treatment) by your housing company based on one or more aspects of your background or identity (e.g., gender, age, ethnicity, sexual orientation, etc.)? Please describe.

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* 10. What is your housing company doing well in terms of building a diverse, equitable, and inclusive community for its residents?

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* 11. Please list any additional comments you would like to share and/or contact information if you would like further discussion about your needs/experiences with an AFHA board member.

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