Thank you for your interest in the upcoming in-person focus groups among community residents. The research will be conducted in early August at a conveniently located community center or conference room in the area. Your responses to this short questionnaire will help ensure a good mix of participants. Your answers will only be used for the purposes of inviting participants to this focus group research.

1.Please indicate your city/town and zip code:

City/Town:

Zip Code:

2.Please provide your contact information which will only be used to invite participants:

First name:

Phone:

Email:

3.How long have you lived in the general area where you live (doesn’t need to be the same home)?

less than a year

1-2 years

3-5 years

6-10 years

11-20 years

more than 20 years

4.Which of the following best describes where you live?

Single-family home

Apartment

Condominium

Townhouse

In a co-operative

Farm

Not currently housed

Other (please specify)

5.Do you own or rent your home?

Own

Rent

Live with family members, but do not own or rent

Other (please specify)