South Madison Heights Comprehensive Project
We Want to Hear From You!!
1. Please rate the overall condition of South Madison Heights.
*
Disappointing
1
2
3
4
Exceptional
5
1 is Disappointing, 5 is Exceptional
2. What do you feel is the greatest need in South Madison Heights? Please check all that apply.
*
Conditions of Housing Stock
Lack of Sidewalks/Streetlights
Lack of Housing Availability
Water & Drainage Problems/Flooding
Street and Roadway Conditions
Lack of Playground/Community Center
Safety/Presence of Crime
Other Issue(s) Not Listed? List Below
If you checked "Other Issue(s) Not Listed", please list below
3. Please rate the overall condition of your street in South Madison Heights.
*
Disappointing
1
2
3
4
Exceptional
5
1 is Disappointing, 5 is Exceptional
4. What do you feel is the greatest need on your block of South Madison Heights? Please check all that apply.
*
Conditions of Housing Stock
Lack of Sidewalks/Streetlights
Lack of Housing Availability
Water & Drainage Problems/Flooding
Street and Roadway Conditions
Lack of Playground/Community Center
Safety/Presence of Crime
Other Issue(s) Not Listed? List Below
If you checked "Other Issue(s) Not Listed", please list below
5. Do you have any suggestions on how to solve/meet these needs in South Madison Heights? If so, please list below.
*
Persons In Household (Including Myself) *Income levels determine housing and community eligibility
Above
Below
1 person / $45,450 (Income Level)
2 persons / $51,950 (Income Level)
3 persons / $58,450 (Income Level)
4 persons / $64,900 (Income Level)
5 persons / $70,100 (Income Level)
6 persons / $75,300 (income Level)
7 persons / $80,500 (Income Level)
8 persons / $85,700 (Income Level)
6. Occupancy Status:
*
Own My Home
Rent My Home
Heir Property/Life Rights
7. Bedroom Size:
*
1
2
3
4
5
1 is , 5 is
8. How many children (under 18) in my home:
*
0
1
2
3
4
5
0 is , 5 is
9. How many elderly (62 years or older) in my home:
*
0
1
2
3
4
5
0 is , 5 is
10. Would you be interested in being contacted in the future with any project updates or would like to be more involved?
*
Yes
No
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Submit
Should be Empty: