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HomeShare Satisfaction Survey
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HomeShare Satisfaction Survey
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HomeShare Satisfaction Survey
How would you rate the safety of the house overall?
Excellent
Good
Fair
Poor
How would you rate the cleanliness & appearance of shared living spaces?
Excellent
Good
Fair
Poor
How would you rate the response time of maintenance staff for repairs?
Excellent
Good
Fair
Poor
How would you rate the response of the case manager to questions or concerns?
Excellent
Good
Fair
Poor
How would you rate the availability of social activities or classes in the house?
Excellent
Good
Fair
Poor
Overall, how would you rate the quality of your housing?
Excellent
Good
Fair
Poor
What do you like best about the HomeShare Housing Program?
What would you change or like to see improved about your housing?
Would you recommend HomeShare to others? Why or why not?
Which of the following activities would you participate in: (check all that apply)
Money management
Job training
Medication management
Floor monitors
Computer training
Arts and crafts
Finding an apartment
Personal counseling
Social activities/resident council
Healthy living skills and techniques
Other (please describe below)
If "Other" is checked above, please describe:
Which of the following do you need, but currently cannot access: (check all that apply)
Money management
Job training
Medication management
Floor monitors
Computer training
Arts and crafts
Housing assistance (search, rental assistance, etc.)
Help with basic living skills
Food assistance (food pantry referrals, etc.)
Employment assistance (job search, resume building, interview skills, etc.)
Transportation assistance (bus tokens, transportation for those with physical disability)
Place to worship
Mental health services
Drug and alcohol counseling and treatment
Other (please describe below)
If "Other" is checked above, please describe:
Demographic Information
The following questions are optional and will help us know who is using our services so we can continue to improve our programs to meet the needs of all clients.
What ethnicity do you identify as?
What is your gender identity?
Female
Male
Transgender Male to Female
Transgender Female to Male
Gender Fluid
Non-binary
An identity not listed (please specify below)
Prefer not to disclose
If you checked "An identity not listed" above, please specify:
What is your age?
How many children are with you in HomeShare?
What is your sexual orientation?
Heterosexual/Straight
Lesbian
Queer
Bisexual
Gay
Questioning
Asexual
Pansexual
Same-gender loving
An identity not listed (please specify below)
Prefer not to disclose
If you checked "An identity not listed" above, please specify:
How long have you been a resident?
Additional Comments or Concerns:
