What county of New York State do you reside in now?
Select One Albany Allegany Bronx Broome Cattaraugus Cayuga Chautaugqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex Franklin Fulton Genessee Greene Hamilton Herkimer Jefferson Kings Lewis Livingston Madison Monroe Montgomery Nassau New York Niagara Oneida Onondaga Ontario Orange Orleans Oswego Otsego Putnam Queens Rennselaer Richmond Rockland St. Lawrence Saratoga Schenectady Schoharie Schuyler Seneca Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates
 

When are you planning on buying or renting?   Choose One WITHIN 1 YEAR WITHIN 5 YEARS AT SOME FUTURE DATE
 

Where would you like to live?  (Select all that apply.)
  City          Suburb          Rural
 

If these options were available, which one would you choose?
Agency run residence          Rental          Buy house         Mobile Home
 

What modifications would you need?
None         Physical          Environmental
Other, explain: 
 

What specific housing needs do you have?
Wheelchair accessibility
Pet accommodating
Close to bus line
Visual door bell
"Visit"ability
Housing advisor or counselor
Aide services
Housemate
Support staff
Other, please explain:
 

If you are considering an agency run residence, what is important to you in making your decision:  (check any that apply)
A bedroom of my own (no roommates)
Input into choosing my housemates
A home close to my family
A home in the neighborhood of my choice
An agency who would work with me and my family on an OPTS proposal
Other; please explain:

 

If you are considering renting, what is important to you in making your decision? (check any that apply)
Affordable
Close to my family
Neighborhood of my choice
First floor apartment
Elevator
Apartment Manager/Management
Other, please explain:
 

If you are considering buying your first home, what is important to you: (check all that apply)
Affordable
Close to my family
It is in the area of my choice
It is a ranch style home
Upkeep/maintenance
Working with a realtor who understands my needs and the ADA regulations
Other, please explain:
 

What do you feel are obstacles to achieving your housing dream?
I don't know where to start
Discrimination
My credit history is poor
I have no credit history
I need help paying the rent
I don't have a security deposit for an apartment
I don't have enough money for a down payment on a home
I don't have enough money for closing costs
I can't afford a house payment
I need help reading and/or filling out paperwork
I need a personal aide
Other; please explain: 
 

Additional comments:

 

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