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* 1. Today's Date

Date

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* 2. First and last name:

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* 3. Organization name:

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* 4. Title:

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* 5. Email: 

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* 6. Business address:

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* 7. Phone number:

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* 8. Do you currently accept HUD Vouchers?

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* 9. What determines your decision to accept HUD Vouchers? Check all that apply.

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* 10. How likely are you to participate in a HUD Voucher Program?

Not at all likely Unsure Extremely likely
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i We adjusted the number you entered based on the slider’s scale.

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* 11. If you have worked with, or are currently working with Community Services, how pleased are you with the management of our HUD grants?

Not at all pleased Neither pleased nor displeased/Not applicable Extremely pleased
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i We adjusted the number you entered based on the slider’s scale.

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* 12. Are you interested in more information about how to become a HUD Housing voucher Program Partner?

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* 13. Do you prefer to include utilities?

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* 14. Will you accept tenants with past evictions?

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* 15. Do you require background screenings?

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* 16. Please tell us about your current unit availability. Indicate how many of the unit types you currently have available in the list below.

T