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* 1. What is your gender?

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* 2. What is your age?

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* 3. In what street is your house located?

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* 4. How long do you reside at this address each year?

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* 5. Does anyone in your household have a disability? [Optional}

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* 6. Are you of Aboriginal, Torres Strait Islander or Pacific Island origin? {optional}

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* 7. How frequently do you participate in activities at QNH?

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* 8. What activities have you taken part in at QNH?

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* 9. How do you usually find out about community events and activities?

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* 10. How would you rate your experience at QNH?

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* 11. What are the main benefits of QNH for you?

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* 12. What activities would you possibly want to do at QNH that are currently not on the program?

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* 13. What programs do you know people are doing in other community centres that QNH could try?

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* 14. Are there other needs or gaps in the programs and services that you think QNH needs to be aware of?

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* 15. What are some important features that make a good community facility?

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* 16. What other particular groups of people do you think  QNH could encourage to be involved at the Neighborhood House?

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* 17. What is one suggestion/comment you would like QNH to consider?

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