Your Voice Matters!

Your Voice Matters!

Resident Survey
Thank you for taking the time to answer these questions. Your feedback helps us create programs and events for the community and connect individuals and families to resources based on your needs and interests.

All fields marked with * are required and must be filled.
Property Name
Property Number
Your Contact Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Email
example@example.com
Phone Number
Please provide a valid phone number.
How do you prefer to be contacted?

SMS TextEmailPhoneFlyer
What is the best time of day to reach you?

MorningAfternoonEveningAny time of day
Community Satisfaction
How would you rate your overall living experience in your building? Use a scale from 10 (best place to live) to 0 (worst place to live)

109876543210
If the decision had to be made today, how likely would you be to renew your lease? Use a scale from 10 (definitely would) to 0 (definitely would not)

109876543210
Please rate your overall satisfaction with the building’s staff in the following areas (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know):
Property Management

43210
Maintenance Staff

43210
Resident Service Coordinator

43210
Security Staff

43210
Leasing Staff

43210
Please rate your overall satisfaction with the following areas (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know):
Quality of your apartment unit

43210
Quality of the building

43210
Cleanliness of the building

43210
Maintenance Requests

43210
Pest Management

43210
Exterior lighting in your apartments

43210
Acoustics (noise) in your apartment

43210
Connection with neighbors

43210
How satisfied are you with the property’s amenities? (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know)
Lobby

43210
Community room

43210
Gym/fitness room

43210
Laundry room

43210
Common areas

43210
Internet/Wi-Fi

43210
Green or open space

43210
Garden/planters

43210
Walkways

43210
Playgrounds

43210
Parking lots

43210
Please rate how safe you feel in the following areas (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know):
Your apartment

54321
Your building

54321
Your building’s parking/outdoor areas

54321
The neighborhood

54321
General comments and feedback:
Community Engagement
How satisfied are you with your social interactions? This includes family, friends, neighbors, religious or social organizations, and activities at the property.

Highly SatisfiedSatisfiedUnsatisfiedVery Unsatisfied
Which factors contribute to your dissatisfaction with social interactions? (Check all that apply)

Lack of time/wrong timeLack of transportationLanguage barriersAvailable opportunities do not interest meSafety concerns
Voting is one way to ensure your voice is heard in both local and national elections. Are you registered to vote?

Registered to vote, voted in last 2 yearsRegistered to vote, not voted in last 2 yearsNot registered to voteNot eligible to vote
Please select which services you are interested in. (Check all that apply)

Leading activities at the propertyResident meetings. Volunteer opportunities. Or social event informationEnrollment assistance with online resident portalVoter registration or voter participation services
Employment
The following questions are regarding paid work experience. Please choose the statement that most closely fits your situation.
What is your current employment status, including self-employment?

Employed full-timeEmployed less than 32 hours per weekEmployed temporarily or seasonallyNot employed
There are many reasons why someone may not be employed. Which reason best explains your situation?

Actively seeking employment, no barriersSeeking childcare to workSeeking/Require education/training program to workRetiredFull-time caregiver/parentEnrolled in education or training programUnable to work and receiving disability benefitsShort term health challengesLack of transportationLanguage barriersArrest recordOther
What work experience do you have?

ManagementBusiness and Financial OperationsComputer, Engineering, and SciencesEducation, Legal, Community Service, Arts, and MediaHealthcare Practitioners and Technical OccupationsHealthcare SupportProtective ServicesFood Preparation and Serving Related OccupationsBuilding and Grounds Cleaning and MaintenancePersonal Care and Service OccupationsSales and Related OccupationsOffice and Administrative SupportFarming, Fishing, and ForestryConstruction and ExtractionInstallation, Maintenance, and RepairProductionTransportation and Material Moving
Please select which services you are interested in. (Check all that apply)

Employment coaching. Resume writing. Finding a job. Or skills training serviceRecord sealing or expungement assistance
Economic Mobility
How likely do you think it is that you will achieve your financial goals within your desired timeframe? Examples of financial goals are moving to a different apartment/home, starting a business, having enough money to retire, etc.

Very likelySomewhat likelyA little likelyNot at all likelyNot applicable, Don’t set financial goals
How well can you manage your expenses?

Can meet everyday expenses and manage emergency or unplanned expensesCan meet everyday expenses but unable to saveCannot meet everyday expensesNo Income
How familiar are you with managing your finances using tools like budgets, credit scores, online bill payments, and tax credits?

Very familiarSomewhat familiarSomewhat unfamiliarVery unfamiliar
How accessible is transportation for you?

Very accessibleMostly accessibleNot very accessibleNot at all accessible
In the past year, did you ever run out of food and couldn't afford to buy more?

NeverOnce or twiceA few monthsMost months
Please select which benefit services you are interested in. (Check all that apply)

Financial benefits. Cash assistance/TANF. Foodstamps/SNAP. SSI/SSDI. Unemployment assistance. Tax rent rebates. Transportation. Or material goods servicesFinancial coaching. Budgeting. Banking. Or tax preparation servicesFood access or food pantry servicesTransportation access or transportation services
Housing

Please choose the statement that most closely matches your experience or situation.
How confident are you in your ability to pay rent on time?

Very confidentSomewhat confidentA little confidentNot at all confident
How well can you manage utility expenses such as heat, electric, gas, oil, phone, and internet?

Very wellWell. Occasional seasonal challenges.Not very well. Often pay late.Not well at all. Currently owe bills.
How safe and healthy is your home or apartment?

Very, no concernsModerately, few concernsNot very, many concernsNot at all, immediate and serious concerns
Please select which services you are interested in. (Check all that apply)

Emergency rental assistance. Online rent payment. Payment plans. Or account balance support servicesEnrollment assistance with online resident portalHousekeeping or pest control servicesReasonable accommodation requests such as grab bars and lowered peep holes.Oil/gas/electric/phone/internet service set up/discount/payment assistance
Education
What is your highest level of education?

No schoolGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 1112th grade, no diplomaHigh School diplomaGEDLess than 1 year of college credit1 or more years of college credit, no degreeAssociate's degreeBachelor's degreeMaster's degreeProfessional degree (e.g., MD, DDS, DVM, LLB, JD)Doctorate degreeI do not know
Please select which services you are interested in. (Check all that apply)

GED. Adult education. English as a Second Language. Digital literacy. Scholarship. Or post-secondary education services
Health
Do you have a primary care physician?

YesNo
Do you see a primary care physician every year?

YesNo
Do you have health conditions that you manage?

YesNo
Do you have health insurance?

YesNo
Do you have access to affordable healthy food?

YesNo
Where have you received medical care in the last year? (Check all that apply)

Doctor or healthcare professional in a local hospitalIn a private officeIn a health centerVAEmergency RoomUrgent careTele-healthWalk-in clinicVisiting nurse association/ on-site servicesOther
Please specify which hospital
Please specify which health center
Please specify other
If you have health insurance, what type of health insurance do you primarily use?

Covered through employer or union (current or former)Purchased insurance from insurance companyMedicare AND Medicaid**Medicare onlyMedicaid/Medical Assistance**TRICARE or other military health careVA health careIndian Health ServiceOther health insurance or health coverage plan
**Medicaid may be called the following depending on your state: Masshealth, Connecticut Medicaid (HUSKY), Rhode Island Medical Assistance, New York Medicaid, New Jersey Family Care, Pennsylvania Medical Assistance, Maryland Medicaid, DC Medicaid, Medi-Cal, Ohio Medicaid, Medical Assistance or MA (Michigan), Health Choice Illinois (HCI), Health First Colorado.
If you are managing health conditions, how confident are you in managing them?

Very confidentMostly confidentA little confidentNot at all confident
To live comfortably, there are many tasks to accomplish such as getting dressed, bathing, and walking. Some people receive assistance with these tasks in their homes. Which describes your situation?

Do not need assistanceCurrently receiving assistanceInterested in receiving assistanceHave difficulty, but do not want assistance
Select all activities for which you are receiving assistance (Activities of Daily Living)

BathingDressingGroomingMouth CareToiletingTransferring to Bed/ChairWalkingClimbing StairsEating
Select all activities for which you are receiving assistance (Activities of Independent Daily Living)

ShoppingCookingManaging MedicationsUsing Phone and Looking-up NumbersCleaning HouseDoing LaundryDriving or Using Public TransportationManaging Finances
Name of person helping

First NameMiddle NameLast Name
Organization (if applicable)
Phone Number of person helping
Please enter a valid phone number.
Email of person helping
example@example.com
Please select which services you are interested in. (Check all that apply)

Crisis support services (please contact 911 if an emergency)Medical care. Dental care. Mental health. Substance abuse. Assistance with daily tasks or health education servicesReasonable accommodation requests such as grab bars and lowered peep holes.
Dependent Child(ren) (0-18yrs.)
Are there children under age 18 living in your home? If "No", then SKIP to Demographic Information.

YesNo
Have your children seen a primary care physician in the last year?

YesNo
Do your children have health insurance?

YesNo
If your children have health insurance, what type of health insurance do you primarily use?

Covered through employer or union (current or former)Purchased insurance from insurance companyMedicaid**TRICARE or other military health careVA health careIndian Health ServiceOther health insurance or health coverage plan
Are your children involved in programs such as early education, afterschool, sports, summer camps, or employment?

Attending quality affordable programAttending programs and looking for other optionsNot enrolled and looking for programsDo not need or want programs for my children
Did your child(ren) advance to kindergarten or the next grade level this past year?

Yes, allSomeNone
Please select which services you are interested in. (Check all that apply)

Early childhood education or childcare servicesParental supportsAcademic assistance. Youth employment. Youth activity. Summer youth program. Or afterschool servicesHealth services for my child
Demographic Information
Race

African American or BlackAsianBi-racialWhiteHawaiian or Pacific IslanderMulti-racialNative AmericanOtherDon't Know/Declined to answer
Ethnicity

HispanicNot HispanicDon't Know/Declined to answer
Language

AmharicArabicCape VerdeanChineseEnglishFrenchHaitian CreoleHindiItalianPolishPortugueseRussianSomaliSpanishVietnameseKoreanOther
Please Specify
Are you a U.S. Veteran?

YesNo
Record ID (do not edit)
Selected Language
Should be Empty:

Your Voice Matters!

Your Contact Information

Community Satisfaction

Please rate your overall satisfaction with the building’s staff in the following areas (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know):

Please rate your overall satisfaction with the following areas (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know):

How satisfied are you with the property’s amenities? (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know)

Please rate how safe you feel in the following areas (4 = Very Satisfied, 3 = Satisfied, 2 = Dissatisfied, 1 = Very Unsatisfied, 0 = Not Available/Don't Know):

Community Engagement

Employment

Economic Mobility

Housing

Education

Health

Dependent Child(ren) (0-18yrs.)

Demographic Information