Thank you for choosing to live in a Homeport community. We are your local resource for quality, affordable housing and connections to customized support that your family may need to create a better life in Central Ohio.

You are invited to take part in a survey about Homeport Resident needs.

This survey is available in other languages upon request, or can be completed over the phone with an interpreter.

Homeport Community Health Survey - Consent Form

Jill Guinan, CHW
Community Health Evaluator
You are invited to take part in a survey about Homeport Resident needs.

What the study is about: This survey will help Homeport find out what services that residents and communities need. 

What you will be asked to do: Answer survey questions about you and your household.

Risks and benefits: There are no anticipated risks to you if you participate in this study, beyond those encountered in everyday life. There are no incentives to complete this survey.

Taking part is voluntary: Taking part in this study is completely voluntary. You can stop at any time. You do not have to answer any questions that you do not want to answer. Your housing will NOT be affected in any way by whether or not you choose to complete this survey.

Your answers will be confidential: All of your answers will be kept on a private database, and will not have your name, address, or personal information connected. Any reports about this survey will not have any identifying information about residents.

If you have questions: If you have any questions, you can contact Jill Guinan by phone at (614)545-4804, or by email at

Complaints: If you have any complaints about any part of the project, or any questions about your rights as a resident, then you may contact:

Morgen Wade
Manager of Research, Compliance & Evaluation

Statement of Consent: I have read the above information, and any of my questions have been answered. I am 18 years of age or older. I agree to take part in this survey.

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* 1. By checking "yes", I agree to participate in this survey.

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* 2. Please let us know if you would like a translated survey or the help of an interpreter.