Please answer the following questions by clicking on the appropriate box for each item listed. Please check only one box per question.

In your current neighborhood, which of the following are missing and rate their importance to you.

Close, caring friendships
Most Important Very Important Somewhat Important Not Important

Status
Most Important Very Important Somewhat Important Not Important

Fun
Most Important Very Important Somewhat Important Not Important

Safety
Most Important Very Important Somewhat Important Not Important

Peace of mind/contentment
Most Important Very Important Somewhat Important Not Important

Which of the following neighborhood features are most important to you and your family?

Price/affordability
Most Important Very Important Somewhat Important Not Important

Affinity with neighbors
Most Important Very Important Somewhat Important Not Important

Exclusivity/status
Most Important Very Important Somewhat Important Not Important

Convenient access to work
Most Important Very Important Somewhat Important Not Important

Rising home values
Most Important Very Important Somewhat Important Not Important

Appearance
Most Important Very Important Somewhat Important Not Important

Neighborhood safety
Most Important Very Important Somewhat Important Not Important

If you were to design your new community, which of the following physical features would you desire most?

Golf course
Most Important Very Important Somewhat Important Not Important

Recreation centre
Most Important Very Important Somewhat Important Not Important

Gate house entrance
Most Important Very Important Somewhat Important Not Important

Childcare center
Most Important Very Important Somewhat Important Not Important

Tennis courts
Most Important Very Important Somewhat Important Not Important

Sidewalks
Most Important Very Important Somewhat Important Not Important

Playground safe from traffic
Most Important Very Important Somewhat Important Not Important

Walking distance from schools
Most Important Very Important Somewhat Important Not Important

Nature preserve
Most Important Very Important Somewhat Important Not Important

Trees, lakes, waterfalls
Most Important Very Important Somewhat Important Not Important

Neighborhood newsletter
Most Important Very Important Somewhat Important Not Important

Neighborhood directory
Most Important Very Important Somewhat Important Not Important

Bookstore/library in your neighborhood
Most Important Very Important Somewhat Important Not Important

Welcome wagon
Most Important Very Important Somewhat Important Not Important

Neighborhood council or association
Most Important Very Important Somewhat Important Not Important

Tutoring services
Most Important Very Important Somewhat Important Not Important

Suggestion box
Most Important Very Important Somewhat Important Not Important

Relationship training
Most Important Very Important Somewhat Important Not Important

Cable TV events directory
Most Important Very Important Somewhat Important Not Important

Computer network access to your home
Most Important Very Important Somewhat Important Not Important

If you were to design your community, which of the following would best fulfill your social needs?

Neighborhood coffee shop
Most Important Very Important Somewhat Important Not Important

Volunteer opportunities
Most Important Very Important Somewhat Important Not Important

Clubs, leagues or common interest groups
Most Important Very Important Somewhat Important Not Important

High status neighborhood
Most Important Very Important Somewhat Important Not Important

Exclusive neighborhood
Most Important Very Important Somewhat Important Not Important

Safe neighborhood
Most Important Very Important Somewhat Important Not Important

Affordability
Most Important Very Important Somewhat Important Not Important

Friendships
Most Important Very Important Somewhat Important Not Important

Baby-sitting co-op
Most Important Very Important Somewhat Important Not Important

Neighborhood block parties
Most Important Very Important Somewhat Important Not Important

If you were to design your community, which of the following would best fulfill your spiritual needs?

Caring neighbors
Most Important Very Important Somewhat Important Not Important

Support groups
Most Important Very Important Somewhat Important Not Important

Opportunity to contribute to others
Most Important Very Important Somewhat Important Not Important

Place to worship
Most Important Very Important Somewhat Important Not Important

Bible teaching/discussion groups
Most Important Very Important Somewhat Important Not Important

Simplified lifestyle
Most Important Very Important Somewhat Important Not Important

Peaceful surroundings
Most Important Very Important Somewhat Important Not Important

Would you share information about you and your family?

Sex
Male Female

Marital Status
Single Married Divorced

Children
Yes No

Number of children

Your Age

Annual Income
Under $25,000
$25,000 to $50,000
$51,000 to 75,000
$76,000 to $100,000
Over $100,000

Currently living
With parents
Single family home
Condo
Rental
Zipcode

If you would like more information about the Institute for Community, please include the following:

Name

Address

City, State, Zip

Phone Number