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SF-01-b
PARTICIPANT NO. 2017 - ______This is your permanent number that will be used in all transactions
SURVEY FORM (Individuals/Professionals/Volunteers)
Dear Participant:
Whether you are an individual, a professional, or a volunteer who wish to share your skills to the organization, we request that you fill up this Survey Form. The results of this survey will be analyzed and the data will be used to determine the skills/services that can be provided by the applicant, as well as, the training/resources he/she needs.
If you are interested in co-owning a housing unit, please fill up Part II. The quantitative data will be used to determine the housing needs of the participant.
Thank you for participating in this survey!
PART I
A. Participant:
Last name: First name: Middle Name: Mr. Mrs. Miss Title____ E mail address: Landline No.:
FaceBook account name: Cellphone No.:
Are you a member of any organization? If yes, please indicate name of organization. POLITICAL SOCIAL PROFESSIONAL Happy Homes community includes spiritual programs. To help the community prepare such programs, kindly indicate your religion. What are your skills/expertise/profession/talent?
What are your hobbies/interests?
What training/resources do you need in the event that you will volunteer your services to the foundation?
Survey Form-RSP_Revised April 2015 Happy Homes is accepting members to its livelihood program. Would you be interested to learn more about how you can earn passive income?
PART II – Proceed answering this part only if interested in co-owning a housing unit.
B. Household Composition
(List yourself on line 1, then list all of the other persons in your household who will be living with you.)
Are you Membership in willing to any of the Full Name Skills/Expertise/ following, Relationship Talents/ share these Age Sex please indicate (surname first) to Applicant Profession skills to the coop? (Pag-ibig, SSS, GSIS, etc) Yes Applicant indicated on page 1 1. No
Yes 2. No
Yes 3. No
Yes 4. No
Yes 5. No
Do you expect the number of people in your family to change within the next 12 months?
(pregnancy, family joining, family leaving) Check if yes. Please explain:
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C. Current Accommodation: (please describe your current accommodation as completely as possible by checking and/or completing the information below.)
Do you:
Rent Own Share Expenses Have Free Accommodation Live in a Co-op
Survey Form-RSP_Revised April 2015 Please state your monthly P rent:
Describe your current accommodation.
(Put )
Apartment Single Detached House Duplex/Row House
Townhouse Condominium Other (Please explain)
Are you willing to live in a residential-commercial townhome located at Tanza, Cavite? Yes No
No. of Bedroom/s your household presently occupies: Preferred number of bedroom/s
Does your present accommodation have a:
Bathroom Private Shared None
Kitchen Private Shared None
Laundry Private Shared None
Outdoor play area Yes No
Do you have any household pets? Yes (It is important that you list all pets) No
Dog Type/Breed (Please indicate):
Other pet/s (please Are you willing to give up Yes indicate) your pet?
D. Finances:
How much are you willing to pay for savings for housing per month?
P200-P300 P1,250- P2,251- P1500 P2,500
P301-P500 P1,501- P2,501- P1,750 P2,750
P501-P750 P1,751- P2,751- P2,000 P3,000
P751- P2,001- Other Amount P1,000 P2,250
How much are you willing to pay for housing amortization per month?
P3,000-P3,999 P5,000-P5,999 P7,000-P7,999 OTHER AMOUNT
P4,000-P4,999 P6,000-P6,999 P8,000-P8,999
Survey Form-RSP_Revised April 2015 E. Business Plans:
Please check which business line you wish to establish:
Grocery Beauty Parlor/Spa Internet Cafe
Laundry Barber Shop Medical/Dental
Pharmacy Restaurant/Food Kiosk Other(pls indicate)
Water Station Business Center
Are you willing to live in a coop community? Yes No Are you willing to abide by coop rules and regulations? Yes No Are you willing to take part in Savings for Housing Program and pay monthly savings? Yes No Are you willing to attend orientation meetings for housing? Yes No Are you willing to attend workshops for housing? Yes No Will you be willing to take in a developmentally challenged adult as a trainee or as Yes No a paid worker under the Foundation’s Sheltered Employment Program? Will you be willing to co-operate a business enterprise with a developmentally-challenged individual?, the business enterprise being funded by the parent of the developmentally- challenged individual through the cooperative.
THANK YOU FOR PARTICIPATING IN OUR SURVEY!
Survey Form-RSP_Revised April 2015