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  2. 2014
  3. June
  4. A
  5. Arise Housing Survey
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Exit Survey
 
 
Hello:
You are invited to participate in our Arise for Social Justice Housing Survey. In this survey, people will be asked to complete a survey that asks questions about Housing in Springfield. It will take approximately five minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Liz Bewsee at 413-734-4948 or by email at the email address specified below.
Liz@arisespringfield,org

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
What neighborhood do you live or are you homeless?
   
Are you staying in a shelter?
   
If so, which one?
   
Do you rent, own, or stay with friends/relatives?
   
How long have you lived there?
   
Do you live alone?
   
If yes how many others live with you?
   
Are you currently facing housing-related problems?
   
If so, what are the issues?
   
Do you and/or your family have challenges paying your rent or mortgage?
   
If so, how long have you had challenges?
   
How many times in the last 5 years have you faced challenges?
   
 
 
 
What other kinds of issues or challenges are you facing? Check all that apply.
 
Loss of job
 
Lack of work
 
Cutback in work hours/wages
 
Loss of spousal income
 
Not enough income
 
Loss of benefits or aid
 
Cuts to benefits or aid
 
Not enough benefits or aid
 
Ineligibility for benefits
 
Loss of other non-wage income
 
Illness/disability
 
Large health care expenses
 
Loss of income due to health or injury of immediate family member
 
Bankruptcy
 
Foreclosure
 
Divorce/separation
 
Lack of internet access in home
 
Child custody issues
 
Death in the immediate family
 
Missing child support payments
 
Transportation issues
 
Language barriers
 
Legal issues
 
Past or present addiction issues
 
Previous conviction for a felony
 
Hunger/Insufficient healthy food
 
Not enough education
 
Homelessness
 
First-hand experience with racist, classist and/or gender discrimination or abuse
 
Other
 
 
 
 
What is your monthly housing cost (rent, mortgage)?
   
is your estimated monthly income (all sources)?
   
 
 
 
What are your income sources?
 
Full time permanent work or business
 
Full time temporary work or business
 
Part time work (20 hours or more)
 
Limited work (less than 20 hours)
 
Casual employment (unsteady)
 
Home-based or internet sales
 
VA benefits
 
Welfare benefits
 
Disability benefits
 
Other
 
 
 
 
If you own your own home, answer the following questions. Otherwise, skip to the next section.
   
Annual taxes for your home
   
Annual water bill for your home
   
Annual cost for home maintenance
   
Have you had any major home expenses in the past year (over $2000)? If so, for what and how much?
   
 
 
 
Monthly electrical bill
   
Monthly telephone/cell bills
   
Estimated monthly food bill
   
Average heating bill (winter)
   
Average summer heating bill
   
Monthly internet bill
   
Monthly health insurance bill
   
Do you have internet in your home?
   
If so, what is your monthly internet bill?
   
If your internet costs are bundled with telephone, cable or other utility, what services is your internet bundled with?
   
What is the total cost?
   
 
 
 
Age
   
Race/Ethnicity
   
Gender
   
Immigrant?
   
GBLTQ?
   
Primary language at home
   
What city do you live in?
   
What city/town/country were you born in?
   
Date
   
 
Thank you for taking our survey. Arise for Social Justice is fighting for change for those of us left out of the decision making process. for more information give us a call or stop into our office. Arise for Social justice 467 State St P.O.Box 5423 Springfield, MA 01101 413-734-4948
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