The City of Beckley, West Virginia is preparing its CDBG Five Year Consolidated Plan, Annual Action Plan, and its Analysis of Impediments to Fair Housing Choice. As part of the planning process, the City is conducting a survey to identify citizens' needs in the community, ideas on how the residents would like to see funds under the CDBG Program spent, and fair housing concerns. Fair Housing concerns include any act of discrimination or barrier that might limit the housing choices of families and individuals. In order for the City to address the housing needs of its citizens, we request your assistance. Please take a few minutes and complete this confidential questionnaire to the best of your ability. If you are unsure of an answer, or the question does not apply to you, please feel free to skip that question. Thank you for your assistance in helping us to identify citizens' needs and Fair Housing issues in the City.

* 1. What is your street name and ZIP Code where you live in the City of Beckley?

* 2. Gender

* 3. Race/Ethnicity (choose all that apply)

* 4. Age

* 5. Number of persons living in your household?