.

Your Home and Community As You Age

 (Queens Community District 2)


Thank you for taking the time to participate in this online survey!


Contact us: udfsurvey@gmail.com

Secured
Survio
Create a survey

YOUR HOME AND COMMUNITY

Please answer the following questions regarding your home and community. 

1

Do you live in Queens Community District 2? (Long Island City, Sunnyside, Sunnyside Gardens, Woodside, Blissville, Hunters Point)

Select one answer.
2

How long have you lived in your current residence?

Select one answer.
3

What is your current living arrangement?

Select all that apply.
4

Which of the following types of homes best describes where you currently live?

Select one answer.
5

How important is it for you to remain in *your current home* as you age?

Select one answer.
6

How important is it for you to remain in *your community* as you age?

Select one answer.
Create a survey

YOUR HOME - FEATURES AND SERVICES

Please answer the following questions about your home.

7

Do you have any of the following features in your home?

Select one answer in each row.
8

Have you experienced any of the following challenges regarding your home?

Select all that apply.
9

Have you used any of the following services at home?

Select one answer in each row.
10

Have you used any of the following services or support systems?

Select one answer in each row.
11

If the cost of your rent increased by $100, would you be able to afford to stay in your home?

Select one answer
12

Are there any other services or supports at home that would be useful to you?

Create a survey

YOUR COMMUNITY

Please answer the following questions about your community.

13

Do you experience any of the following mobility and access challenges in your community?

Select all that apply.
14

How easy is it to get to the following destinations or use the following services in your community?

Select one answer in each row
15

What community supports would aid you as you get older?

Select all that apply.
Create a survey

ABOUT YOU

Please answer the following questions regarding yourself.

16

What is your gender?

Select one answer.
17

What is your age group?

Select one answer.
18

What is your marital status?

Select one answer.
19

What is your race/ethnicity?

Select all that apply.
20

What was your annual household income before taxes last year?

Select one answer.
21

Are you enrolled in any of the following programs?

Select all that apply.
22

What is your employment status?

Select one answer.
23

How many people including yourself live in your home?

Please list how many members are in each category.
24

Is there anything else you would like to share with us about what would support you as you get older in your home or community?

Create a survey
Thank you for your time and feedback.

If you would like to enter into the raffle for the $50 gift card

and/or

If you would like to participate in a focus group to provide additional thoughts about living in your community as you get older


Please click here!


Contact us: udfsurvey@gmail.com

Share this survey to help us get more responses...