Survey Draft 1

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Survey Draft 1

About the house and household (to be filled out only once per user)

Please enter the following information about your housing unit:

Make

**note from Nicole**, ideally we could have drop-down menus for models offered by each maker? and an other box

Model:

Year of Manufacture:

Which of the following describes this housing unit?

Travel Trailer/Camper

Mobile Home

Park Model

Modular Home

Other:

Clear selection

Zip Code (maybe this should be turned to state if we ask zip in login-NS)

Please describe your use of this unit

**NOTE FROM NICOLE: seems like we should split this into several questions: 1) what do you use the unit for (recreation or primary residence, other), 2) do you own, rent, or otherwise occupy the unit, 3) if you don't own it, who does?

Your primary residence that you own

Your primary residence that your rent

Your recreational residence that you own/rent

A unit you are considering buying/renting

The property of a friend or relative

A unit you own with the intention of selling

A unit that you lived in after you were displaced by a disaster

The property of a stranger

Other:

Who did you buy/rent/inherit this home from?

Business name (if individual, please indicate individual's name)

City, State of purchase (please seperate by comma)

Move-in (or purchase date if unoccupied)

YYYY

Do you know or suspect that this unit is a FEMA trailer or FEMA mobile home?

Yes

Other:

Clear selection

How many people currently live in the unit?

(4 or more nights per week)

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms