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* 1. What Municipality do you live in?

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* 2. What ZIP Code do you live in?

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* 3. What is your gender?

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* 4. What is your race? Please choose all that apply.

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* 5. What is your Ethnicity?

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* 6. What is your age group?

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* 7. How many people are living in your household?

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* 8. Based on the number of persons living in your household, mark whether your household income is more or less than the listed income:

  More Less N/A
1-Person Household - $55,100
2-Person Household - $62,950
3-Person Household - $70,800
4-Person Household - $78,650
5-Person Household - $84,950
6-Person Household - $91,250
7-Person Household - $97,550
8-Person Household - $103,850

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* 9. What is your current housing status?

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* 10. Identify housing/rental issues you have observed in the County of Northampton (Choose all that apply):

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