Monacan Indian Nation Housing Assessment
Household Screener
* Required
Email address
*
Your email
How would you prefer to be contacted about important Tribal information? Email (must provide valid email address), Online Services (Monacan website or social media platforms), or Mail (must provide valid and current mailing address).
*
Your answer
Respondent's Age Group
*
18-24
25-44
45-54
55-64
65 and older
Respondent's ethnic/racial affiliation(s). Mark all that apply.
*
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
White/Caucasian
Black/African American
Other
Don't Know
Decline to answer
Required
Tribal Affiliation
*
Enrolled
Not Enrolled
If Enrolled, please specify which Tribe or Nation.
Your answer
County of Residence
*
A. AMHERST
B. ROCKBRIDGE
C. NELSON
D. AUGUSTA
E. ALBEMARLE
F. BOTETOURT
G. APPOMATTOX
H. BEDFORD
I. CAMPBELL
J. BUCKINGHAM
K. NONE
L. DON'T KNOW
DECLINE TO ANSWER
Other:
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