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* 1. What is your gender identity?

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* 2. What is your age?

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* 3. What is your race or ethnicity?

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* 4. What is your highest level of education

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* 5. My total family income last year was:

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* 6. Which of the following categories best describes your employment status?

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* 8. How long have you lived in your neighborhood?

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* 9. Select the option that best describes your relationship with your neighbor?

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* 10. Do you rent or own your house?

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* 11. If you rent, how would you describe your relationship with your landlord

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* 12. How many people live in your home?

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* 13. Your neighborhood...

  Strongly Disagree Disagree Neutral Agree Strongly Agree Don't Know
Has adequate lighting on public streets
Is clear of litter and debris
Has plenty of public spaces and parks
Has adequate bike lanes
Has easy access to public transit
Has well-maintained roads for travel
Has access to community gardens
Has a voice in city matters and decisions

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* 14. Housing in your neighborhood

  Strongly Disagree Disagree Neutral Agree Strongly Agree Don't know
Is in good condition
Is racially diverse 
Is affordable to a variety of incomes and age ranges

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* 15. Safety in  your neighborhood

  Strongly Disagree Disagree Neutral Agree Strongly Agree Don't Know
You feel safe walking in your neighborhood during the day
You feel safe walking in your neighborhood at night
You feel your neighborhood is a safe and healthy place for children

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* 16. Economic status of your neighborhood

  Strongly Disagree Disagree Neutral Agree Strongly Agree Don't Know
Adequate places to buy healthy food at fair prices
Opportunities to establish new locally-owned businesses
Has a variety of eateries (more than fast food)
Has a variety of retail stores
Has too many empty storefronts
You can run the majority of your errands in your neighborhood
You can afford the majority of your purchases in your neighbhorhood

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* 17. Education in your neighborhood

  Strongly Disagree Disagree Neutral Agree Strongly Agree Don't Know
There is adequate access to K-12 public schools
You believe in the competency of the public school system to educate and safeguard your child(ren) 
There is access to private/charter schools
There is access to post-secondary education
There is access to vocational training and education
There is access to job training
There is adequate childcare that is affordable to a variety of incomes
There are adequate and affordable afterschool programs

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* 18. Community engagement in your neighborhood

  Strongly Disagree Disagree Neutral Agree Strongly Agree Don't Know
Your neighborhood supports one another
Your neighborhood works with local businesses to improve quality of life in the area
Your neighborhood works with local non-profits to improve quality of life in the area
Your neighborhood is actively working to create a brighter tomorrow for future generations
Your neighborhood is active with the neighborhood association and/or block clubs
You are aware of opportunities and events in your neighborhood
You are aware of news and developments in your neighborhood

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* 19. In your own words:

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* 20. Are you willing to volunteer and get involved in the betterment of our neighborhoods?

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* 21. What programs do you feel would be beneficial in your neighborhood?

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* 22. If there is anything else you would like to tell us about your community/neighborhood, please do so here: 

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