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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 home 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. Before finding out about this survey, had you heard of Queenscliff Neighbourhood House [QNH]?

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* 8. What activities do you think QNH offers?

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* 9. What is the main reason you have not participated in any activities at QNH?

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* 10. What activities would you possibly want to do at QNH?

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

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

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* 13. Which of the following sections of the community do you think use QNH the most?

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

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

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

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