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* 1. What is your full name?

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* 2. Where do you currently reside? E.g. Te Muriwai, Manutuke, Gisborne etc.

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* 3. Do you...

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* 4. Currently, how many people live in your household?

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* 5. Are there any children under 18 in your household? If yes, how many and age of each?

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* 6. Are there any kaumātua in your household? If yes, how many and age of each?

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* 7. Does anyone in your household suffer from any illness, disability or require special assistance? If yes, how many and what are the requirements?

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* 8. What are your primary housing concerns? E.g. overcrowding, rent.

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* 9. Are you planning to build in the Tairāwhiti region within the next 5 years? If yes, are there any constraints with your build? Please give detail i.e. resource and building consents, whenua, finance.

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* 10. Are you planning to purchase a home in the Tairāwhiti region within the next 5 years? If yes, are there any constraints? Please give detail i.e. the process for purchase, understanding bank lending requirements.

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* 11. If you are a homeowner in the Tairāwhiti region, are you planning to renovate your existing home within the next 5 years, for the purpose of improving your current living conditions? If yes, please give detail i.e. living in damp conditions, house extension due to overcrowding, special needs.

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* 12. Any further comments?

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