Independence Landing

Independence Landing Inc is a non-profit corporation created by concerned parents of young adults with special needs in Tallahassee, FL. Its aim is to build a new housing option for disabled individuals who can live independently with some support from the community, fellow residents, family, friends and/or caregivers. Our vision is a planned, affordable and safe residential campus with amenities that would allow residents to successfully lead independent and fulfilled lives. This will not be a group home. It will be similar to a town-home or upscale apartment-style living.

As part of our mission to develop a supportive, protected and fair housing for future residents, we ask your participation in filling out this survey. Your input is crucial to the planning, implementation and evaluation of this community housing program.

The information that you provide will be kept strictly confidential.  Submitting this survey WILL NOT determine eligibility, secure placement nor put you on the waiting list. If you have received this survey from more than one source, please complete it only once.

Thank you for sharing your ideas with us as we find solutions that address future residents’ unique needs and preferences.


The following questions should reflect the personal views and choices of the individual with special needs. The person completing this survey on behalf of the applicant will need to provide their contact information at the end of the survey.

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* 1. The person completing this survey is: (please select one)

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* 2. Please provide the information of interested resident.

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* 3. What state COUNTY do you currently live?

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* 4. What is the date of birth of Interested Resident?

Interested Resident DOB: (MM/DD/YYYY)

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* 5. Which of the following best describes the Interested
Resident’s disability? (Please check all that may apply.)

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* 6. What support or assistance do you currently need? (Please check all that may apply.)

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* 7. What  period of time can you be left unsupervised and
alone?

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* 8. Are you currently receiving Medicaid Home & Community
Based Waiver Services?

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* 9. What is your current living situation?

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* 10. What is your marital status?

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* 11. Have you previously lived on your own?

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* 12. Have you ever been Baker Acted, Marchman, Ex Parte,
Parens Patriae committed or arrested?

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* 13. In the past five years, have you experienced issues with: (Please check all that may apply.)

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* 14. What support services are you currently receiving at home and/or from service provider/s?
(Please check all that may apply.)

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* 15. Have you considered other possible residential options?

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* 16. What type of dwelling would you prefer : (check only
one)

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* 17. What is the maximum amount that you could afford for
monthly rent and utilities?

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* 18. Based upon the estimated rents established by the
Florida Housing Tax Credits Program, which living
arrangement best fits your budgetary situation?

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* 19. How soon would you be ready to move? (check only
one)

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* 20. What are your monthly sources of income and benefits?
(Please check all that may apply.)

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* 21. What is your total monthly income? (choose the closest
number)

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* 22. Do you work or participate in any of the following daily
activities? (check only one)

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* 23. How many hours per week (average) do you work or
volunteer? (check only one)

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* 24. How long have you been employed or have volunteered?

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* 25. Please rank the following services and choices in terms of importance to you:

  Very Important Important Not Important Not At All Important
Daytime Activities
Recreation & Social Activities
Job Skill Training
Employment Opportunities
Continuing Education
On-Site Dining
Living With or Close to My Family & Friends
Personal Safety
Life Skill Training
Medication Supervision and Administration
Transportation

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* 26. Are you willing to move to our  Tallahassee location from your current
residence?

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* 27. What amenities or features are important to have within
the community? 

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* 28. When was your primary caregiver born?

Caregiver's Birth Date (MM/DD/YYY):

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* 29. Would you like to receive our email newsletter and
updates?

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* 30. The date this survey was completed:

Date / Time

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* 31. Would you be interested in volunteering in Independence Landing’s
project? Become part of our community and experience the joy and
gratification of enhancing the lives of Independent Landing residents. 
You will be matched to an assignment based on your skills, talents and
interests.

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* 32. Contact information for the person assisting individual with
special needs in completing this survey:

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* 33. Would you consider donating to this planned residential
community for individuals with special needs?
Fundraising will remain a critical factor in order to complete this
this project. Our ongoing effort to address the unprecedented and intensive
housing needs of this vulnerable population, will give them a
place where they have a sense of community and belonging.
Thank you for your support.

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