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* 1. Are you a DC resident? If no, do not complete the survey.

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* 2. What ward do you live in?

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* 3. How long have you lived in your ward?

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* 4. How long have you lived in the District of Columbia?

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* 5. What is your zip code?

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* 6. What is your gender?

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* 7. What is your marital status?

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* 8. What is your age range?

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* 9. What is your or race or ethnic group?

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* 10. Were you born in the United States?

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* 11. What is the primary language spoken in your home?

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* 12. What is your annual household income?

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* 13. Please indicate your highest educational level:

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* 14. What best describes your employment status? (Select all that apply)

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* 15. If others live with you, please indicate the age ranges that best describe the majority of those who live with you.

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* 16. If others live with you, what is your relationship to them? (Check all that apply)

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* 17. Which of the following best describes your household situation?

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* 18. If you rent, do you receive Section 8, rental assistance or a housing voucher?

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* 19. Do you have health insurance?

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* 20. Since a year ago, would you say that your health insurance or health care coverage is better, worse or about the same?

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* 21. Is there anyone in your household (including yourself) who has any of the following health conditions? (Check all that apply)

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* 22. United Planning Organization (UPO) offers many services. Have you needed or received assistance with any of the following in the past 12 months? Select all that apply.

  Did Not Need Assistance with this or N/A Needed Assistance Received Assistance Choose not to answer
Finding Housing/Shelter
Obtaining Transportation
Obtaining Healthcare/Insurance
Medicaid/Medicare
Income Tax Preparation
Referrals/Information
Utilities
Child care services
Child support
Employment services
Immediate Crisis Assistance
Family/Individual Counseling
Work Readiness / Job skills
Clothing
Skills Training
Food
Food stamps/SNAP
Mental Health Services
Alcohol or drug abuse counseling
TANF (Temporary Assistance to Needy Families)
Unemployment Compensation
Supplemental Security Income (SSI or SSD) (Disability)
College or Trade/Technical School
Adult Education (GED, Adult Basic Education)

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* 23. Have you ever received assistance or services from the United Planning Organization (UPO)?

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* 24. Did UPO’s services/programs help you in achieving your goals?

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* 25. How would you rate the following services that you received at UPO? Please check one.

  Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied
Customer Sevice
Overall Experience

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* 26. How or what can UPO do better to assist you to assure that your needs are being met?

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* 27. Were there any other needs you had in the past year, other than those listed above?

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* 28. Did you face any difficulties meeting basic needs (food, shelter, employment) in the past year?

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* 29. If you faced difficulties meeting basic needs, what problems did you face when trying to get help? (Check all that apply).

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* 30. If there were a vacant lot on your block, please select your TOP THREE preferences for how the District should use the land.

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* 31. How much do you agree with the following statement:
I feel included in the decisions of what my neighborhood would look like in the future?

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* 32. How involved would you like to be in the decisions that affect what your neighborhood would look like in the future?

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* 33. How much do you agree or disagree with the following statement:
I feel safer in my neighborhood than I did last year.

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* 34. On a scale from Very Respectful to Very Disrespectful, please indicate the extent to which you believe the police have generally been respectful of your rights as a citizen.

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* 35. To what extent do you agree with the following statement:
I can afford to continue to live in my neighborhood.

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* 36. If I had a choice to send my children to school elsewhere, I would still send my children to my neighborhood school.

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* 37. The District of Columbia guarantees Pre-K education for 3 and 4 year olds.

I believe this is a worthy investment of government funds.

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* 38. What is your level of confidence in the DC government’s ability to provide jobs?

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* 39. What do you like best about your neighborhood?

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* 40. What improvements would you like to see in the District of Columbia?

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* 41. Please indicate the degree of concern you have that the following type of crime might happen in your neighborhood:

  Very Concerned Some Concern No Concern
A. Murder
B. Violent Assaults
C. Motor Vehicle Theft
D. House - Breaking in and entering
E. Robbery from a person
F. Sexual Assault
G. Domestic violence involving partners
H. Gang violence

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