Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Survey Questionnaire by FFT115

VIEWS: 0 PAGES: 6

									Survey No.           ____                Interviewer   ____________________
Team No.             ____                Date          ____________________
Census Tract No.     ____                Time          ____________________
Block Group No.      ____
Block No.            ____

Survey Questionnaire – Fall 2009

1. How long have you lived in this neighborhood?
1 = Less than 2 years
2 = 3 to 5 years
3 = 6 to 10 years
4 = More than 10 years
7 = Can not choose/Refused

2. What is your age?
1 = 18 to 34 years
2 = 35 to 54 years
3 = 55 to 74 years
4 = 75 years or older
7 = Can not choose/Refused

3. What is your education level?
1 = Kindergarten or less
2 = Less than High school Graduate
3 = High school graduate
4 = Some college or associate degree
5 = Bachelor’s degree
6 = Master’s degree or higher
7 = Can not choose/Refused

4. How many adults, including yourself, live in your household?
1=1
2=2
3=3
4=4
5=5
6 = 6 or more
7 = Can not choose/Refused




                                                                          1 of 6
5. How many children under the age of 18 years live in your household?
0=0
1=1
2=2
3=3
4=4
5=5
6 = 6 or more
7 = Can not choose/Refused

6. What race or ethnicity do you consider yourself?
[Allow multiple categories only if respondent asks]
1 = White, Caucasian, or European
2 = Hispanic, Mexican-American, or Latino
3 = Portuguese
4 = Asian [if yes, ask follow-up: 41- 44]
       41= East Asian
       42= South Asian
       43= Pacific Islander
       44= Middle Eastern
5 = Black or African American
6 = Other: (fill in) _____________
7 = Can not choose/Refused

7. Were you born in the U.S. or another country?
1 = U.S. (please skip question 8)
2 = Other country [ask follow-up: 21]
       21= What country were you born in? (fill in) ____________________________
7 = Can not choose/Refused

8. If you were born outside the U.S., how long have you lived in the U.S.?
1 = Less than 2 years
2 = 3 to 5 years
3 = 6 to 10 years
4 = More than 10 years
7 = Can not choose/Refused

9. Generally speaking, how would you rate your neighborhood as a place to live?
1 = Excellent (skip question 10)
2 = Good
3 = Average
4 = Poor
5 = Very poor
7 = Can not choose/Refused (skip question 10)




                                                                             2 of 6
10. If you answered good, average, poor or very poor in response to the above
question, what steps do you think should be taken to improve your neighborhood?
(OPEN-ENDED; RECORD VERBATIM BELOW)




11. Would you say that the street lighting at night in your neighborhood is:
1 = Excellent
2 = Good
3 = Average
4 = Poor
5 = Very poor
7 = Can not choose/Refused

12. Would you say that your neighborhood has gotten better or worse compared to
the same time last year?
1 = Much better
2 = Somewhat better
3 = The same
4 = Somewhat worse
5 = Much worse
7 = Can not choose/Refused

13. Do you know if there's a neighborhood group or association in this area? If yes,
have you ever attended a meeting?
1 = I am not aware of the existence of a neighborhood association in this area.
2 = I am aware of the existence of a neighborhood association in this area, but I have
    never attended any of its meetings.
3 = I am aware of the existence of a neighborhood association in this area, and I have
    attended at least one if its meetings.
7 = Can not choose/Refused

14. Overall, how much impact do you think people like you can have in making your
community a better place to live?
1 = Big impact
2 = Moderate impact
3 = Small impact
4 = No impact at all
7 = Can not choose/Refused



                                                                                 3 of 6
15. In a typical month do you purchase a good or service at any of the following
local shopping districts?

a. East Santa Clara Street          c. South 24th Street
1=Yes                               1=Yes
2=No                                2=No

b. McKee Road                       d. Alum Rock Avenue
1=Yes                               1=Yes
2=No                                2=No

[IF NO TO ALL, SKIP TO Q18]

16. [IF YES] Which location do you frequent the most?
1= East Santa Clara Street
2= McKee Road
3= South 24th Street
4= Alum Rock Avenue

17. [IF YES] How do you typically travel to this location?
1= On foot (walking)
2 = By bike
3 = By public transit (bus, streetcar)
4 = By car

18. Do you happen to know the name of the city council member who represents this
area?
1 = Yes
2 = No (SKIP TO Q20)
7 = Can not choose/Refused (SKIP TO Q20)

19. (For those who say they know the name): Can you please tell me the council
member’s name?

______________________________ (Record the name and SKIP TO Q21)
7 = Refused

20. (For those who say they don’t know the name): The city council member for this
area, his name is Sam Liccardo – does that name sound familiar to you?
1 = Yes
2 = No (SKIP TO Q22)
7 = Can not choose/Refused (SKIP TO Q22)




                                                                               4 of 6
21. Would you say that you generally approve, somewhat approve, somewhat
disapprove or generally disapprove of the way Sam Liccardo is handling his job as
city council member for this area?
1 = Generally approve
2 = Somewhat approve
3 = Somewhat disapprove
4 = Generally disapprove
7 = Can not choose/Refused

22. Do you think your neighborhood has become more safe in the last year or less
safe?
1 = More safe
2 = Less safe
3 = About the same (volunteered response)
7 = Can not choose/Refused

23. Apart from us/me conducting the interview today, have you noticed any other
students or personnel affiliated with San José State University working or helping
out in your neighborhood?
1 = Yes
2 = No
7 = Can not choose/Refused

24. Are there any adults in your household who do NOT have health insurance?
1 = Yes
2 = No
7 = Can not choose/Refused

25. [IF YES] Are any of the uninsured adults in your household employed?
1 = Yes
2 = No
7 = Can not choose/Refused

26. Are there any children in your household between the ages of 0-5 who do NOT
have health insurance?
1 = Yes
2 = No
7 = Can not choose/Refused

27. Are there any children in your household between the ages of 6-18 who do NOT
have health insurance?
1 = Yes
2 = No
7 = Can not choose/Refused




                                                                               5 of 6
28. Do you own or rent the place here where you live?
1= Rent
2 = Own/Bought
7 = Can not choose/Refused


Thank you for your cooperation in completing this survey!




The following questions should be answered by the interviewer based on observation
(DO NOT ASK).

29. Housing type:
1 = Single Family
2 = Duplex
3 = Multi-Family (3 to 9 units)
4 = Multi-Family (10 or more units)
5 = Residential hotel, rooming or boardinghouse
6 = Mobile home or trailer
7 = Other

30. Gender
1 = Male
2 = Female

31. Language of the Survey
1 = English
2 = Spanish
3 = Vietnamese
4 = Other




                                                                                 6 of 6

								
To top