Housing Survey

 

            General Resident Information

Name: _________________________________________________

Address: _______________________________________________

Email: _________________________Phone:___________________

How many children (under the age of 18) live in your home?_________

 

How long have you lived at this address? _______________

 

Do you currently rent your own home?        Yes q             No  q

Do you currently own your own home?       Yes q             No q

 

 

            Neighborhood Characteristics

 

Does your home need repairs?      Yes q             No q

Are there vacant lots on your block?           Yes q           No q

Are there abandoned, vacant or for sale homes on your block?   Yes q       No q

If your home does need repairs, would you participate in a home improvement program, if offered by Good Neighborhoods?      Yes q         No q

 

What kinds of housing improvements do you think need to be made to your block or area to make it a better place for youth to live? (Please check all that apply)

q     Housing Repairs/ Rehabilitation

q     Rebuild Abandoned Homes

q     Foreclosure Prevention

q     Add street signs and lights

q     Yard/ Lot Improvements

q     Garage Repairs

q     Vacant Lot Maintenance

q     Other _______________

q     Other _______________