Housing Authority of the Sac and Fox Nation Housing Needs Assessment
Data collected will be used to assist the Housing Authority in determining if there is a need for elder housing, the identified area for elder living units and to guide the Housing Authority with the development of new units in identified locations.
Personal Data
(For Raffle Use Only)
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Gender
Male
Female
Age
Current Marital Status
Married or living with partner
Single/Never Married
Divorced or Separated
Widow
What zip code or county do you currently reside in?
Are you an enrolled member of a federally recognized tribe? If yes, please list your tribal affiliation.
What type of housing do you presently have?
House-Own
Apartment
House-Rent
Trailer or Manufactured Home
RV
Homeless
Other
Are you living with family members, non-family members or alone?
With family members
Alone
With non-family members
With both family and non-family members
How many (including yourself) live in your household?
Do you think designated elder housing units should be a top priority for the Housing Authority to develop?
Yes
No
Rank the locations (Stroud, Cushing, Shawnee) in need of elder housing in order of importance with 1 being the most important and 3 being the least important.
Do you think Stroud needs more housing units? If yes, do you think there needs to be more 1 or 2 bedroom units?
Do you think Cushing needs more housing units? If yes, do you think there needs to be more 1 or 2 bedroom units?
Are you currently using any of the following services? (Please mark all that apply)
Home delivered meals
Home health care
Transportation
None
Which do you think should be a priority between elder only housing or new units for Stroud &/or Cushing?
Elder only housing
New units for Stroud &/or Cushing
What community services do you think are needed in close proximity to elder housing?
What are some suggestions for new &/or needed services with the Housing Authority?
Submit
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