This free survey is powered by
0%
Exit Survey
 
 
Hello:
You are invited to participate in our survey to identify what Homeless Needs and Gaps exist in your community. To try and serve you better, we want to ask you some questions about your situation.  Please do not provide your name or anything that identifies who you are.   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.  Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
What is your gender?
 
Male
 
Female
 
Other
 
 
Are you a veteran?
 
Yes
 
No
 
 
How old are you today?
 
18-25
 
26-30
 
31-40
 
41-50
 
50+
 
 
Are you disabled?
 
Yes
 
No
 
 
If you answered 'yes' to being disabled, please identify your disability?
 
Physical/Medical
 
Mental health
 
HIV/AIDS
 
Substance Abuse
 
Developmental
 
Other
 
 
If you identified a disability, is it
 
Clinically diagnosed
 
Self diagnosed
 
 
Are you currently homeless? (Living in shelter, transitional housing, on the street, or places not meant for human habitation.)
 
Yes
 
No
 
 
If homeless, check your reason() why:  Check all that apply.

 
Domestic Violence
 
Family Break-up
 
Fire/other disaster destroyed my home
 
Unable to pay rent
 
Evicted due to non-payment of rent
 
Evicted for other reasons
 
Discharge from an institution
 
Other
 
Share This Survey:          Surveys Powered by  QuestionPro Survey Software