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Short Creek Community Utility Survey
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1.
Please answer these questions for you and your immediate family/household (that you include on your tax return), not for renters or others that may live on or in your property. Please encourage renters/others to fill out the survey separately.
(Required.)
Got it!
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2.
What is your gender?
(Required.)
Female
Male
Prefer not to say
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3.
What is your age?
(Required.)
17 or younger
18-20
21-29
30-39
40-49
50-59
60 or older
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4.
What is the highest level of school you have completed or the highest degree you have received?
(Required.)
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Trade school or technical certificate
Associate degree
Bachelor degree
Graduate degree
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5.
Which of the following categories best describes your employment status?
(Required.)
Employed full time, working 32 or more hours per week
Employed part time, working 1-31 hours per week
Not employed, looking for work
Not employed, NOT looking for work
Retired
Disabled, not able to work
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6.
How much total combined money did all members of your HOUSEHOLD earn last year?
(Required.)
$0 to $9,999
$10,000 to $24,999
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $124,999
$125,000 to $149,999
$150,000 to $174,999
$175,000 to $199,999
$200,000 and up
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7.
Which town do you live in:
(Required.)
Hildale
Colorado City
Other (please specify)
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8.
In total, how many years have you lived in this community?
(Required.)
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9.
Did you or any members of your family (by blood, marriage or adoption) originate in this community?
(Required.)
Yes
No
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10.
Are you the head of household? (Answer yes if you provide support for legal dependants.)
(Required.)
Yes
No
Other (please specify)
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11.
What is your household size?
(Required.)
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12.
How many parents live in your household?
(Required.)
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13.
How many children/dependents (including adult children)
(Required.)
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14.
How many children under the age of 6?
(Required.)
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15.
How many other or unrelated household members?
(Required.)
0
1-2
3-5
6-10
10-20
20+
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16.
Housing: Do you
(Required.)
Own (including buying)
Rent (including UEP occupancy agreement)
Live with relatives or friends
Couch Surf
Live in a shelter or other institution
Homeless
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17.
Do you feel like housing is affordable and available in this community?
(Required.)
Both available and affordable
Available but not affordable
Affordable but not available
Neither available nor affordable
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18.
What portion of your household has health insurance (from any source, including private, employment or medicaid)?
(Required.)
All
Most
Some
A few
None
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19.
What is something about our community that really works?
(Required.)
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20.
What is something about our community that could be improved?
(Required.)
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21.
How involved are you in the community (Volunteer, participate in local celebrations, initiatives, etc)
(Required.)
None at all
A little
A moderate amount
A lot
A great deal
22.
If you are involved, volunteer, or otherwise engaged in the community outside of your paid job, what are the ways you participate?
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23.
Are you registered to vote?
(Required.)
Yes
No
I don't know
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24.
Did you vote in the last election?
(Required.)
Yes
No
I don't know
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25.
Did you complete the 2020 Census questionnaire?
(Required.)
Yes
No
I don’t know
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26.
What resources/services exist in the community? Please list all you can think of
(Required.)
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27.
What resources/services do you have to leave the community to access or receive?
(Required.)
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28.
Do you have any disabled/special needs individuals in your household?
(Required.)
Yes
No
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