Métis Citizenship

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* 1. What City or Town or rural area do you live in?

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* 2. Are you a member of a Métis Local? If so which Local?

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* 3. How many people in the household identify as Métis?

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* 4. How many people in the household have updated Métis citizenship cards?

  Male Female
16-19 years
20-44 years
45-64 years
65 & older
Household Structure

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* 5. How many people in the house have applied or are currently applying for their Métis cards?

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* 6. How many people of each age and sex are there in your household? Are they ?

  Métis Non Status First Nation Non-Indigenous
Female - 0-9 years
Female - 10-15 years
Female - 16-19 years
Female - 20-44 years
Female - 45-64 years
Female - 65-74 years
Female - 75 & older
Male - 0-9 years
Male - 10-15 years
Male - 16-19 years
Male - 20-44 years
Male - 45-64 years
Male - 65-74 years
Male - 75 & older

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* 7. Describe the household structure.

Declaration of Income

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* 8. What is the combined average total income of the household?

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* 9. Please identify your source of income.

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* 10. Is there anyone in the house that is homeless or couch surfing? Homeless being defined as without a home or emergency sheltered, or unsheltered and living on the streets, or provisionally sheltered or at the risk of homelessness. Couch surfing is staying with other people short term.

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* 11. Is there anyone living in the household that is not homeless but requires additional support or service to maintain stable housing due to challenges with disabilities, mental health issues, addiction issues, behavioural issues, etc.

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* 12. Is there anyone living in the household who is homeless and requires additional support or service to maintain stable housing due to challenges with disabilities, mental health issues, addiction issues and/or behavioural issues, etc.

Current Household Costs

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* 13. How much does your household pay in rent/mortgage on a monthly bases?

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* 14. What amount does your does your household currently contribute to utility expenses monthly?

Status of Current Home

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* 15. How long has your household resided in the current home?

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* 16. What type of home you are currently residing in?

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* 17. Number of bedrooms in your current home?

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* 18. Number of bathrooms in current home?

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* 19. What type of heating system does your house operate on?

Home Living Status

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* 20. Does the household own, rent, etc. the home?

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* 21. If given the opportunity to rent or own, which option would be preferred?

Home Condition

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* 22. Please give the reasons if your current home does not meet your household needs. Choose all that apply.

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* 23. Do you have any of the following housing related needs? Choose all that apply.

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* 24. When was your current home built?

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* 25. Overall, describe the condition of the home?

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* 26. If in poor condition, describe?

Housing Satisfaction

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* 27. Please rate the level of satisfaction the household has with their current home.

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* 28. Has the household's housing situation improved or deteriorated in the last 5 years?

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* 29. Please identify any other challenges/issues with your housing needs.

PATHWAYS TO WELLNESS
Recreation

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* 30. From the list below, indicate those facilities that your family (living in your household) used over the last year:

Household Education

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* 31. From the list below, indicate those services that your family (living in your household) used over the last year.

Senior's Care

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* 32. Check all that apply from the list below. Long term care is:

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* 33. Check all that apply from the list below. Assisted living is:

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* 34. Check all that apply from the list below. Home care is:

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* 35. Check all that apply from the list below. Mental health services are:

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* 36. Check all that apply from the list below. The Elder's complex is:

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 100% of survey complete.

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