Interest Survey for Stepping Stone Communities' Integrated and Intentional Apartment Building
This interest survey is to be completed by the person with disabilities who has an interest in potentially living in a neuro-diverse apartment building in Littleton, Colorado. If the person with disability needs help filling it out, a family member or other support person can help. But the questions should be answered from the point of view of the future potential resident. This is NOT AN APPLICATION, just an interest survey so we can have a better idea of what you would like in a future housing option.
Email address *
Potential future resident's name:
Your answer
Name of person completing this survey (if not the potential future resident)
Your answer
Person filling out this survey- What is your relationship to the potential future resident? *
1. What county do you currently live in? *
2. What is your current living situation? *
3. Which of the following demographics do you feel best describes you?
4. How would you best describe your disability, if applicable? (check all that apply) *
5. How old are you (the future potential resident)? *
6. Select your current income and/or public benefit sources (check all that apply): *
7. The maximum I could afford to pay in rent each month is: *
8. Are you currently receiving Home and Community Based Services through a Waiver from your local CCB (Community Center Board) *
9. If yes, what Waiver services are you currently receiving?
10. How would you describe your support needs (check all that apply)? *
11. Are you employed or do you participate in other meaningful daily activities? *
12. How many combined hours per week (average) are you typically out of your home working, volunteering, attending day program and/or other activities? *
13. Do you feel like any of the following are barriers to you accessing your community (check all that apply)? *
14. What do you feel are the barriers to maintaining friendships? *
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