CAPK Housing Questionnaire

Kern County Housing Needs Assessment

Thank you for participating in this survey. The information collected will hep us get a better picture of housing needs in the community. Completing this survey is voluntary and will not affect your ability to receive services. All information collected is confidential and no identifying information will be shared.

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* 1. How did you hear about this survey?

Head Start

Food Bank

WIC

211

Energy Program

VITA

Friendship House Community Center

Shafter Youth Center

Migrant Childcare

East Kern Family Resource Center

Church

Other (please specify)

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* 2. Which of the following best describes your current living arrangements? (Please choose one box)

House

Apartment

Condo

Townhouse

Mobile Home

Homeless

Other (please specify)

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* 3. Which of the following best describes your household arrangement? (Please choose one box)

Owns (with or without a mortgage)

Rents privately

Rents Section 8/Voucher

Rent to Own (shared ownership)

Rents Affordable Housing (must qualify)

Rents from employer of, or tied to job of, member

Other (please specify)

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* 4. How many people currently live in your household? (Please choose one box)

5+ (please specify)

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* 5. How many bedrooms are in your home? (Please choose one box)

Other (please specify)

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* 6. Of the individuals that live in your household, what are their ages? (Choose all that apply)

0-9 years

10-14 years

15-19 years

20-44 years

45-64 years

65-74 years

75 years and over

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* 7. What is your household's gross (before taxes and other deductions) income for all people living in the home 18 years and older? (Fill in the blank)

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* 8. What type of income are you receiving? (Please mark all that apply)

Wages/salary

SSI

SSI/Disability

TANF(Public Assistance)

Other (please specify)

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* 9. What best describes your employment status?

Unemployed

Full-time

Part-Time one job

Part-Time more than one job

Retired

Other (please specify)

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* 10. How much do you pay in rent/mortgage?

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* 11. Do you ride public transportation?

Yes

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* 12. If not, what would get you to ride public transportation?

A stop closer to my home

More frequent routes

A bus shelter or other covering at the bus stop

If it were cheaper

If there was a stop to this destination or other (please specify)

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* 13. Can CAPK Contact you for additional information?

Yes

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* 14. Contact Details-If you provide your details below, you may be contacted for additional information.

Name

Address

Zip Code

Email Address

Cell Phone or Home Number

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* 15. In order to monitor the effectiveness of our Equal Opportunities Policy, we ask you to provide the following demographic information. This information is voluntary and will help us better assess what is needed to help people with housing. Please click one box only for each question.

What is your gender?

Male

Female

Non-Binary

Other

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* 16. What is your age? (Please choose one box)

0-24

25-44

45-64

65-74

75+

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* 17. What is your race?

White

Hawaiian or Pacific Islander

Asian

Native American/Alaskan Native

African American

Latino or Hispanic

Sikh/Indian American

Other (please specify)