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* 1. What age group do you belong to?

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* 2. Where do you reside?

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* 3. Do you own or rent your home?

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* 4. If you like, please tell us the name of the street on which you live:

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* 5. How long have you been a resident of the Town or Village?

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* 6. How many people live in your household?

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* 7. How many people in your household completed this survey?

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* 8. How would you describe your status? (Check as many as apply)

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* 9. If employed, where do you work?

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* 10. Are you served by any of the following Town/Village services (check all that apply)?

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* 11. If you responded “None of the above” to the above question, please check the services you would like to receive:

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* 12. Would you like to see more housing available in the Town?

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* 13. If you answered Yes to the above, what type of housing would you like to see? (Check all that apply)

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* 14. If you suggested types of housing above, please suggest locations for the types of housing you chose

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* 15. Do you feel there is a lack of fresh food choices in the Town/Village of Champlain?

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* 16. Please rank in order of importance the following topics in relation to the Town/Village of Champlain (1 being least important).

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* 17. What are three (3) things you like about living in the Town or Village of Champlain?

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* 18. What are three (3) things you dislike about living in the Town or Village of Champlain?

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* 19. On a scale of 1 to 5 (1 being the lowest, 5 being the highest) how would you rate the overall appeal of the Town of Champlain?

  1 2 3 4 5
Low to High

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* 20. On a scale of 1 to 5 (1 being the lowest, 5 being the highest) how would you rate the overall appeal of the Village of Champlain?

  1 2 3 4 5
Low to High

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* 21. What goods, services, or industries would you most like to see expanded in the Town/Village? (Check all that apply).

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* 22. If you operate a business in the Town or Village of Champlain, how do you rate the current business climate in your community?

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* 23. What businesses or types of businesses would you like to see expanded in the Town/Village of Champlain? Enter none if you would not like to see any business expanded.

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* 24. How do you mostly get around the community?

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* 25. What transportation challenges do you feel need to be addressed in the Town/Village of Champlain?

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* 26. To what extent do you agree that the Town and Village of Champlain embraces diversity, equity, and inclusion in its services, facilities, and community events?

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* 27. Do you have concerns about safety and security where you live?

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* 28. Please use this space to provide any additional input or information you would like the Comprehensive Plan Committee to consider as they develop the Comprehensive Plan.

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* 29. Would you be willing to volunteer to serve the community in some capacity?

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* 30. Name, contact information (optional):

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