1.What is your age?

18-20

20-22

22-24

24+

2.What is your gender identity?

Female

Male

Another gender that is neither female nor male

Other (please specify)

3.What is your race?

Caucasian

African American/Black

Asian

Hispanic/Latino, a, X

Native American/Alaskan, Indigenous 

Pacific Islander

Other (please specify)

4.Do you have any Foster Care involvement? 

Yes

No

5.How long have you been homeless or doubled up?

1 week- 1 month

1 month - 3 months

3 months - 6 months

6 months - 1 year

1 year or more

6.If there were a transitional housing program available, would you be interested in it?

Yes

No

7.What type of services would you like available in a transitional housing program?

Basic life skills e.g: Cooking, Cleaning etc. 

Resume Writing

Job Searching

Budgeting

Reading and understanding a lease

Other (please specify)