NJDH Survey
Survey Responses
Are you interested in living in affordable housing in New Jersey designed for those who are Deaf, Hard of Hearing, DeafBlind or Late-Deafened?
Where do you live now?
What is your current living arrangement?
If an apartment became available, could you move in three (3) months?
Please tell us the number of people in your household who are:
0
1
2
3
More than 3
Over age 55
45 - 55
21 - 44
Under 21
Check all that apply for the people in your household:
Do you have a service animal?
How many bedrooms do you want?
Do you need a parking space?
Contact Information
Name:
Your answer
Street address:
Your answer
City:
Your answer
State:
Your answer
Zip:
Your answer
Phone:
Your answer
My phone is:
Email:
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service