Vertical Watch ProgramĀ©
Exhibit #5 - Sample Vertical Watch Survey - Part 2


(Please feel free to copy off this survey.)

  13.   We are considering offering space in our newsletter for members to advertise items for
          sale, trade or exchange and also a lost and found section. Ads will sell for $1.00 for 25
          words. If this form of advertising was available, would you use it?

          Yes     No

  14.   Would you pay to advertise in the newsletter?

          Yes     No

  15.   Do you think it would be a good idea to post these newsletter ads somewhere in the
         building, say in the lobby or laundry room?

          Yes     No

  16.   Would you like to see comments from building security included in the newsletter?

          Yes     No

  17.   Would you like to see information from the police included?

          Yes     No

  18.   Comments from property management included?

          Yes     No

  Please complete this next section. Your answers will help us decide which activities to pursue in the future. We will treat this information with the strictest confidence. It will not be used for any purposes other than to prepare the results of this Vertical Watch survey. No personal information will be divulged or published.

20.   Your name__________________________________________________________

21.   Your Apt No.________________________________________________________

22.   Age:     20-40      41-64      65+

(Please circle which age group applies to you.)

23.   Do you have any children living with you in your apartment?

          Yes     No

          If you do, please indicate how many there are and their respective ages?

          boy(s)______ ages(s)_______          girl(s)______ages(s)_______

24.   Does anyone living in your apartment have a disability?

          Yes     No

          If you answered yes, please describe the nature of any disability. For example, walk with
          a cane, use a wheelchair, hearing impaired, deaf, blind, poor eyesight, heart problem, etc.
          Print clearly.
         ___________________________________________________________________
         ___________________________________________________________________
         ___________________________________________________________________
         ___________________________________________________________________

25.   Are you a shut-in?

          Yes     No

  Thank you for participating in our survey. If you wish to make further comments or suggestions, write them on another piece of paper and include it along with this survey. Be sure to drop off your completed survey at (drop off location) before (date) deadline.

Additonal surveys are available from:

"Back to first page of Sample Survey"


 

verwatch@netcom.ca

 

View Our Guestbook Sign Our Guestbook

  This page accessed times.